Laparoscopic Spleen Removal (Splenectomy)
WHAT IS THE 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. The spleen can affect the platelet count, the red blood cell count and even the white blood count.
HOW DO I KNOW IF MY SPLEEN SHOULD BE REMOVED?
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 reason is a condition called idiopathic (unknown cause) thrombocytopenia (low platelets) purpura (ITP). Platelets are blood cells which aid blood clotting.
- Hemolytic anemia (a condition that breaks down red blood cells) may requires a spleen removal to prevent or decrease the need for transfusion.
- Hereditary (genetic) conditions that affect the shape of red blood cells, conditions known as spherocytosis, sickle cell disease or thalassemia, may require splenectomy.
- Patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, may require spleen removal.
- Sometimes the spleen is removed to diagnose or treat a tumor.
- The blood supply to the spleen may becomes blocked (infarct) or the artery abnormally expands (aneurysm) in these conditions the spleen may needs to be removed.
AM I A CANDIDATE FOR LAPAROSCOPIC SPLEEN REMOVAL?
Most patients can have a laparoscopic splenectomy. Though the experience of the surgeon is the biggest factor in a successful outcome, the size of the spleen is the most important determinant in deciding whether the spleen can be removed laparoscopically. When the size of the spleen is extremely large, it is difficult to perform the laparoscopic technique. Sometimes, plugging the artery to the spleen right before surgery using special X-ray technology can shrink the spleen to allow the laparoscopic technique. You should obtain a thorough evaluation by a surgeon qualified in laparoscopic spleen removal along with consultation with your other physicians to find out if this technique is appropriate for you.
HOW IS LAPAROSCOPIC REMOVAL OF THE SPLEEN PERFORMED?
- Under general anesthesia, so the patient is asleep throughout the procedure.
- Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button. Your abdomen will be inflated with carbon dioxide gas to create a space to operate.
- A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a monitor.
- Two to three cannulas are inserted for placement of instruments which allow your surgeon to delicately separate the spleen from its attachments.
- A search for accessory (additional) spleens and then removal of these extra spleens will be done since 15% of people have small, extra spleens. 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 incisions. The spleen is broken up into small pieces within the special bag and completely removed.
ADVANTAGES OF LAPAROSCOPIC SURGERY
- Less postoperative pain
- Shorter hospital stay
- Faster return to a regular, solid food diet
- Quicker return to normal activities
- Better cosmetic results