Author/Editor		Donini, Annibale; Terrosu, Giovanni; Baccarani, Umberto; Bresadola, Vittorio; Sistu, Marco; Vianello, Valentina; Anania, Gabriele; Risaliti, Andrea; Barillari, Giovanni; Uzzau, Alessandro; Bresadola, Fabrizio
Title		Laparoscopic splenectomy - our experience with 36 consecutive cases
Translated title		Laparoskopska splenektomija - izkušnje s 36 bolniki
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 3, št. 5
Publication year		1998
Volume		str. 23-8
Language		eng
Abstract		Backgraund. After being successfully applied to the treatment of other abdominal organs, the laparoscopic approach was introduced in spleen surgery by Carroll in Los Angeles in 1991. Patients and methods. Since October 1993, we have performed 36 laparoscopic splenectomies. Ptroprtsyibr fishnoses were idiopathic thrombocytopenic purpura (ITP) (21 cases), Hodgkin's disease (HD) (6 cases), non Hodgkin's lymphoma (NHL) (4 cases), hereditary spherocytosis (HS) (2 cases), chronic lymphatic leukemia (CLL) (1 case), splenic myelofibrosis (1 case) and splenic cyst (1 case). Patients with lymphoma had complete laparoscopic lymph node staging and bilateral liver biopsies according to the Stanford's protocol. With the patient in anti-Trendelenburg's position, and the operating surgeon standing between the patient's legs, 4 to 5 trocars are introduced into the upper abdominal quadrants, and the hilum of spleen is isolated. Hilar vessels are dissected and upper abdominal quadrants, and the hilum of spleen is isolated. Hilar vessels are dissected and upper abdominal quadrants, and the hilum of spleen is isolated. Hilar vessels are dissected and ligated with a surgical stapler. A plastic bag is introduced into the abdominal cavity; the spleen is slipped into the bag and after previous morcellation extracted through an umbilical incision. Results. The advantages of laparoscopic splenectomy over open operation include lesser postoperative pain, lower incidence of pulmonary complications and subphrenic abscesses, faster restoration of bowel movement, shorter hospitalization period and better cosmetic results. The lower incidence of postoperative sequelae is associated with shorter hospital stay and, consequently, with reduced costs of treatment. Conclusions. Laparoscopic splenectomy is a safe technique for the management of several haematologic diseases with some clear advantages over the open approach.
Summary		Izhodišča. Po uspešni uveljavitvi laparoskopske kirurgije trebušnih organov je bila prvič opravljena laparoskopska odstranitev vranice v Los Angelesu leta 1991 (Carroll). Bolniki in metode. Od oktobra 1993 smo opravilli 36 laparoskopskih splenektomij. Predoperativne diagnoze so bile: idiopatska trombocitopenična purpura (21 primerov), Hodgkinova bolezen (6 primerov),ne-Hodgkinov limfom (4 primeri), prirojena sferocitoza (2 primera), kronična limfatična levkemija (1 primer), mielofibroza vranice (1 primer) in ena cista vranice. Pri bolnikih z limfomi smo napravili tudi celovito zamejitev bolezni v trebušni votlini in obojestransko biopsijo jeter po stanfordskem protokoluy. Bolnik je med operacijo v antitrendelenburgovem položaju, kirurg stoji med nogami bolnika. Štiri do pet troakarjev uvedemo v zgornjo polovico trebuha in izoliramo hilus vranice. Žile v hilusu zapremo in prerežemo s spenjalnikom. Vranico položimo v plastično vrečko, ki jo po drobljenju parenhima odstranimo skozi odprtino ob popku. Rezultati. Med prednosti laparoskopske splenektomije lahko navedemo zmanjšano pooperativno bolečino, zmanjšanje incidence pljučnih zapletov in subfreničnih abscesov, krajše trajanje pooperativnega ileusa in hospitalizacije. Vidne so tudi "kozmetske" prednosti. Zmanjšanje pooperativnih zapletov skrajša hospitalizacijo in zmanjša stroške. Zaključki. Laparoskopska splenektomija pri številnih hematoloških boleznih je varna in ima določene prednosti pred splenektomijo s klasičnim pristopom.
Descriptors		SPLENECTOMY SURGERY, LAPAROSCOPIC SPLENIC DISEASES