Stapleless Laparoscopic Splenectomy with Individual Vessel Dissection in Patients with Splenomegaly

Tan, Jun; Chu, Yajuan; Tan, YunChang; Dong, Jiahong

doi:10.1007/s00268-013-2152-0

Cited by 5 publications

(3 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The maneuver using Endo GIA to staple and mutilate the splenic pedicle directly is called the primary pedicle dissection, while the secondary pedicle dissection refers to separation and ligation of second branches of the splenic pedicle individually [20] . Currently there are 3 ways to manipulate the splenic pedicle in total laparoscopic surgeries: (1) Ligating the second branches of the splenic pedicle with clips or threads of silk: A study reported by Tan et al [21,22] has introduced a method applying double ligation of proximal splenic vessel with a thread of silk and occlusion of distal part with a titanium clip, and they proved that it is feasible, effective and cheap; (2) manipulating the splenic pedicle with Endo GIA: it is simple, safe and effective, which make it the favorite method chosen by most doctors at home and abroad, though more expensive [20] ; (3) processing the splenic pedicle with LigaSure vessel-sealing equipment: it has been developed for the safe closure of arteries up to 7 mm in diameter [23] . But the data for venous closure are rare, some study stated that it can be used to close veins up to 12 mm in diameter [24] and can treat grades 3 and 4 of hemorrhoids [25] .…”

Section: Discussionmentioning

confidence: 99%

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

Wang

Tang

Zhang

et al. 2015

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

View full text Add to dashboard Cite

This study was aimed to explore prevention and treatment of hemorrhage during laparoscopic splenectomy plus devascularization (LSD) for portal hypertension by modified and simplified operation. From June 2012 to June 2014, LSD was performed on 138 patients with portal hypertension. The patients were allocated into two groups: earlier stage (ES) group, in which 45 patients received traditional LSD from June 2012 to Sep. 2012; later stage (LS) group, in which 93 patients underwent modified LSD from Jan. 2013 to June 2014. Perioperative variables were compared between the two groups. Laparoscopic operations were successfully performed in all but two patients in ES group who were converted to laparotomy (total conversion rate: 1.4%). There was no perioperative death or reoperation, and all patients recovered and were discharged from hospital with no serious complications in the six months of postoperative follow-up. The average time in the ES group was longer than that in the LS group (335.1 min vs. 201.3 min, P<0.05). LS group outperformed ES group in terms of blood loss (705.4 mL vs. 910.4 mL, P<0.05). The average operation time to oral diet intake after surgery (40.5 h vs. 50.3 h, P<0.05) and postoperative hospital stay (7.4 d vs. 9.0 days, P<0.05) were much less in the LS group than in the ES group. The overall complication rate (4.3 % vs. 11.1 %, P<0.05) and conversion rate (0% vs. 4.4%, P<0.05) were lower in the LS group than in the ES group. It was concluded that prevention and treatment of hemorrhage are the key points of LSD for portal hypertension. By creating a tunnel above the splenic pedicle and a tunnel behind the lower esophagus, the simplified and modified LSD can reduce hemorrhage and improve success of surgery dramatically, and splenomegaly and severe varices are not contraindications.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

Wang

Tang

Zhang

et al. 2015

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

View full text Add to dashboard Cite

show abstract

“…For the control of the vessels in the splenic hilum, we initially used a vascular stapler, and after 2006, we employed individual vessel dissection and clips, similarly to the method described by Tan in their paper published in 2013. 17 Similarly to Tan, we found the method to be safe, especially in the case of splenomegaly when the positioning of the stapler would be difficult because of the reduced space. There are papers about managing the splenic hilum with a…”

Section: The Effect Of the Learning Curve (Study Ii)mentioning

confidence: 75%

“…(Figure 2) For the control of the vessels in the splenic hilum, the Endo GIA stapler was used in the learning period until 2006, which was later replaced with individual vessel dissection and Hem-o-lok clip ligation. 17 The dissection of the hilum, similarly to the method of Tan, was performed from anterior to posterior and from inferior to superior directions, which made the identification of the vessels and the pancreas easy, and with which the risk of pancreatic injury could be minimized. (Figure 3) If the patient requires platelet transfusion, it should be administered after the ligation of the splenic artery.…”

Section: Surgerymentioning

confidence: 99%

Minimal invasive surgery of the spleen

Nyilas

View full text Add to dashboard Cite

A laparoszkópos splenectomia 1991-es bevezetése óta gold standarddá lépett elő a lép sebészetében, és a nyitott műtéttel szembeni előnyei vitathatatlanok. Habár a műtéti idő jellemzően hosszabb LS esetén, viszont a splenectomiával öszefüggő morbiditás ritkább, és a posztoperatív hospitalizáció rövidebb. Az irodalomban igen korlátozott számban állnak rendelkezésre magyar betegpopuláción végzett vizsgálatok eredményei. A laparoszkópos lépsebészet 1994-ben került bevezetésre a Szegedi Tudományegyetem Sebészeti Klinikáján, és az azóta eltelt időben munkacsoportunk szerezte meg az egyik legnagyobb tapasztalatot a témában Magyarországon. Habár a laparoszkópos technikát kezdetben splenomegalia esetén kontraindikáltnak tartották, idővel bebizonyosodott a módszer biztonságossága extrém méretű lépek esetében is. Ahogy a laparoszkópos eljárás az extrém nagy méretű lépek esetében is elterjedt, felmerül az olykor 2000 grammnál is nagyobb tömegű specimen eltávolításának nehézsége. A szokásos eljárás a specimen Endobagbe helyezése, és valamelyik port helyén morcellációval történő eltávolítása. A kézzel asszisztált laparoszkópos splenectomia (HALS) esetén kézenfekvő a specimen hand-port helyén történő eltávolítása. Ezen eljárások mellett ismert a specimen Pfannenstiel-metszésből történő eltávolítása is. Irodalmi adatok alapján a lépméret mellet a learning curve bír még kiemelt jelentőséggel a splenectomia eredményeire. A splenectomia leggyakoribb indikációja az idiopátiás thrombocytopéniás purpura (ITP). Tekintettel az ITP immunológiai mechanizmusára, az első vonalbeli standard terápia kortikoszteroidok, illetve iv. immunglobulinok adása. Amennyiben a betegek az elsődleges kezelésre nem reagálnak, vagy a betegség reagál ugyan, de folyamatos gyógyszerelést igényel, refrakter ITP-ről beszélünk, mely miatt második vonalbeli kezelés jön szóba. Ez lehet Rituximab, TPO receptor agonisták, valamint a splenectomia, melyek közül a splenectomia biztosítja a legjobb és legtartósabb eredményt (80% körüli válasz, 60% 5-10 évig). A laparoszkópos eljárás számos előnye miatt évtizedek óta elfogadott sebészi módszer az ITP kezelésében. A módszer hematológiai eredményessége a hagyományos splenectomiához hasonló. Mindezek mellett csak nagyon korlátozott számban állnak rendelkezésre standardizált definiciókat és kimeneteli kritériumokat figyelembe vevő közlemények a splenectomia hosszú távú eredményeiről. Tekintettel arra, hogy a splenectomizált betegek mintegy 15-25 %-ánál nem vezet azonnali eredményre, illetve a betegek 1/3-a a későbbiekben relapszusba kerül, fontos lenne prediktív faktorok meghatározása a felesleges műtétek elkerülése, a terápia tervezhetősége érdekében. A splenectomia sikerességének megjóslására számos hipotetikus prediktív faktort vizsgáltak. Irodalmi adatok szólnak az életkor, a szteroid terápiára adott válasz, a perioperatív thrombocyta érték, valamint a thrombocyta sequestratio jellegének prediktív értékéről.

show abstract

Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension

Liu

Zhao

Tang

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

View full text Add to dashboard Cite

Although the clinical benefit of laparoscopic splenectomy and devascularization (LSD) has been elaborated in many studies, its application in massive splenomegaly remains controversial. We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension. Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study, and divided into two groups. Twenty-one patients underwent open splenectomy and devascularization (OSD) from June 2010 to October 2012 (OSD group). From March 2013 to February 2015, LSD was performed on 26 patients (LSD group). Perioperative variables were analyzed. Compared to OSD, LSD was associated with less blood loss (241.9±110.0 mL vs. 319.0±139.5 mL, P<0.05), more rapid resumption of oral diet (2.46±0.95 days vs. 3.76±1.09 days, P<0.05), and shorter postoperative hospital stay (5.35±1.65 days vs. 7.24±1.55 days, P<0.05). It was concluded that for patients with massive splenomegaly due to portal hypertension, LSD is feasible and as safe as OSD.

show abstract

Stapleless Laparoscopic Splenectomy with Individual Vessel Dissection in Patients with Splenomegaly

Cited by 5 publications

References 38 publications

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

Minimal invasive surgery of the spleen

Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension

Contact Info

Product

Resources

About