Laparoscopy Surgery

PERSONALIZED PATIENT CARE

Laparoscopic Splenectomy Treatment

Splenectomy means surgical removal of spleen. The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called "macrophages" (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria.

There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons. The most common conditions that warrant Splenectomy in an adult are:

  • Trauma to the organ
  • Blood disorders like Hemolytic anemia (a condition that breaks down red blood cells)
  • Enlarged spleen
  • Benign tumors of the spleen
  • Auto immune diseases of the spleen
  • Spleenic cysts
  • Selected leukemias or lymphomas that affect the spleen
  • Genetic conditions that affect shape of RBC, like hereditary spherocytosis in which there are abnormally sphere shaped red blood cells or Thalassemia major

An evaluation typically includes a complete blood count (CBC), a visual look at the blood cells placed on a glass slide called a 'smear', and often a bone marrow examination. Sometimes an ultrasound examination of your spleen, a computerized tomography (CT scan), magnetic resonance imaging (MRI) or nuclear scan is needed.

There are two ways to perform Splenectomy: open or laparoscopic. But not all patients are candidate for open method. Certain conditions like in cases of trauma where intra-abdominal bleeding interferes with the surgeon's ability to visualize the blood vessels, requires open surgery. Spleens which are massively enlarged may also pose a problem for the surgeon because the size of the spleen restricts the visualization and manipulation of the spleen.

Sometimes the surgeon may decide to convert the laparoscopic surgery to an open procedure in certain situations and for patient safety. Though very infrequent, when conversion to an open technique occurs, it should not be considered a failure of the procedure. In other situations, one of the small incisions may be enlarged some for better handling of the spleen. This is called 'laparoscopically assisted' or 'hand assisted laparoscopic splenectomy' and is particularly helpful in the very large spleens.

Traditionally, removal of the spleen has been accomplished using one larger incision. Since the cut is big, it takes more time to heal compared to laparoscopic incision. Open Splenectomy would require hospitalization for 3-7 days and 2-6 weeks for a full recovery.

Laparoscopic or minimally invasive approach involves specialized video equipment and instruments that allow a surgeon to remove the spleen through several tiny incisions, versus a traditional large midline incision for an open approach.

After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery. Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery.

The laparoscopic Splenectomy is usually performed with general anesthesia. An IV line will be placed in your arm for fluids and you will be brought into the operating room. The anesthesiologist and nurses will use monitors to check your heart rate and breathing during the procedure. These may include EKG leads, a blood pressure cuff, an oxygen mask and sleeves on your legs to prevent clots from forming.

The patient will be placed under general anesthesia. A cannula (hollow tube) is placed into the abdomen by the surgeon and the abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which project a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on the abdomen to allow the surgeon to place instruments inside your belly to work and remove the spleen. After the spleen is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions on your abdomen. The spleen is broken up into small pieces (morcelated) within the special bag and completely removed. Laparoscopic splenectomy requires three or four small incisions ranging from 1/4 to 1/2 inch. Additionally there is a small incision usually 4-5 cm in length that is used to extract the spleen

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment.

After surgery you will be given intravenous fluids (IV's) in your arm. You may have a stomach tube coming up out your nose to prevent vomiting or stomach bleeding because your stomach can fill up with stomach juices and not empty properly after this surgery. Not every surgeon uses this tube. You will be given pain medication to relieve the discomfort you may experience from the small incisions. You will need to let your nurse and surgeon know what your pain medication needs are since everyone has a different pain threshold.

The surgery is done as an overnight stay in most patients. The remaining patients typically go home the following day. Patients can resume light daily activity immediately. Most patients after laparoscopic surgery will experience a sharp shoulder pain that resolves after 2-4 hours. It is important that patients get out of bed and go for a walk as soon as possible (the night of surgery), to improve lung function and decrease the risk of abnormal blood clots. The average patient will require 1-2 weeks recovery before resuming more vigorous activity. There is no forced limitation of activity, instead patients are asked to advance their activity as tolerated. This applies to the resumption of work, sports, and sexual activity.

Results may vary depending on your overall condition and health. Usually laparoscopic method has added benefits. They are :

  • Less postoperative pain
  • Shorter hospital stay
  • Faster return to a regular, solid food diet
  • Quicker return to normal activities
  • Better cosmetic results

The table given below compares the laparoscopic and open surgery.

LAPAROSCOPIC

  • Small Incisions (less than ½ an inch)
  • Hospital stay is 1 to 3 days
  • Patients usually return to work in 5 to 10 days
  • Lesser risk of Infection
  • Less painful
  • Less chance of hernias

OPEN

  • Large Incision
  • Hospital stay of about 5 days
  • Return to work in about 4 weeks
  • Greater risk of infection
  • More painful
  • More chance of hernias

Splenectomy, either open or laparoscopic, is a safe procedure. But as with any other surgical procedure however, complications may occur. The risk of surgery is also related to the disease process for which the Splenectomy is being performed. As with any other operation involving the abdomen, injury to abdominal organs and tissues is a potential risk.

Complications following laparoscopic Splenectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case. Possible complications may include:

  • Cannula site infections,
  • Pneumonia,
  • Internal bleeding or
  • Infection inside the abdomen at the site where the spleen used to be,
  • The pancreas can become inflamed (pancreatitis).