We have extensive experience with these specialized solid organ procedures. We often are able to help our patients to a very rapid recovery through truly minimally invasive techniques. In the past, making a large 6 to 12 inch incision in the abdomen or flank was necessary to remove a diseased spleen. With modern laparoscopic technique, the surgery can be performed through three or four 1/4-1/2 inch incisions. Patients may leave the hospital in one or two days and return to work more quickly than patients recovering from open surgery.
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. The most common reason is a condition called idiopathic (unknown cause) thrombocytopenia (low platelets) purpura (ITP). Platelets are blood cells which aid in blood clotting. Hemolytic anemia (a condition that breaks down red blood cells) requires spleen removal to prevent or decrease the need for transfusion. Also, hereditary (genetic) conditions that affect the shape of red blood cells, conditions known as spherocystosis, sickle cell disease or thalassemia, may require splenectomy. Often patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, require spleen removal. When the spleen gets enlarged, it sometimes removes too many platelets from your blood and has to be removed. Sometimes the spleen is removed to diagnose or treat a tumor. Sometimes the blood supply to the spleen becomes blocked (infarct) or the artery abnormally expands (aneurysm) and the spleen needs to be removed.
HOW ARE THESE PROBLEMS FOUND?
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.
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC SPLENECTOMY?
Results may vary depending on your overall condition and health. Usual advantages are:
- Less postoperative pain
- Shorter hospital stay
- Faster return to a regular, solid food diet
- Quicker return to normal activities
- Better cosmetic results
ARE YOU 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. Your surgeon will help you select the best procedure for your medical condition.
WHAT PREPARATION IS REQUIRED?
- Immunization with a vaccine to help prevent bacterial infections after the spleen is removed should be given two weeks before surgery, if possible.
- Routine surgery preparation will be scheduled by your surgeon
HOW IS LAPAROSCOPIC REMOVAL OF THE SPLEEN DONE?
You will be placed under general anesthesia and be completely asleep. A trocar (hollow tube) is placed into the abdomen by your surgeon and your 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 trocars which projects a video picture of the internal organs and spleen on a television monitor. Several trocars are placed in different locations on your abdomen to allow your surgeon to place instruments and remove your spleen. 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 removed, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small incisions on your abdomen. The spleen is then broken up into small pieces (morcelated) within the special bag and completely removed.
The latest innovation in spleen surgery is the use of the surgical robot. We are now able to offer Robotic Surgery for a variety of spleen problems. The robot can increase our precision, and new developments continue to improve the lives of our patients. The robot may be offered for selected patients and conditions. Please feel free to discuss this with your surgeon.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?
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. The decision to convert to an open procedure is strictly based on patient safety.