Site FeedbackSuggested Links:
Laparoscopic Splenectomy
You May Have These Symptoms
You may notice that you bruise easily and that the bruises take a long time to disappear.
An enlarged spleen may have been felt by your doctor during a physical examination or seen on an x-ray. Perhaps you have had an unexplained infection somewhere and through diagnostic testing, a problem with your spleen is discovered.
[back to top]What are the Indications for Splenectomy?
- Trauma
- Blood disorders
- Enlarged spleen
- Benign tumors of the spleen
- Auto immune diseases of the spleen
- Splenic cysts
- Selected leukemias or lymphomas that affect the spleen
What are the Contraindications for Laparoscopic Splenectomy?
Laparoscopic removal of the spleen is not recommended for cases of trauma because intra-abdominal bleeding interferes with the surgeon's ability to visualize the blood vessels and splenic attachments. 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. Portal hypertension is usually another contraindication to any type of splenectomy.
What is Laparoscopic Splenectomy?
Laparoscopic splenectomy is the surgical removal of the spleen. It differs from the traditional 'open' technique in that the procedure is performed through small incisions. This usually allows a much faster recovery and is significantly less painful.
How is Laparoscopic Splenectomy Done?
Laparoscopic splenectomy is a surgical technique used to remove the spleen without making a large incision. You will be given general anesthesia. After you are asleep the anesthesiologist will probably insert a temporary tube into your stomach to empty it. This will help to decompress the stomach and prevent post-operative nausea. A catheter will be inserted into your bladder to drain the urine while you are asleep. Surgery may be done with you lying flat on your back or turned onto your right side depending on surgeon preference. Several small incisions are made into the abdomen. One is used for the laparoscope which is attached to a camera that sends images to a video monitor. The other incisions are used to hold or manipulate tissue in the abdomen. Carbon dioxide gas is insufflated into the abdominal cavity to allow room to work and to allow the surgeons to see. Parts of the spleen are freed from surrounding tissue. Blood vessels to the stomach and spleen are visualized, tied off or clipped with metal clips and divided. Once the spleen is dissected free of its attachments in the abdominal cavity, it is placed in a special surgical plastic bag and removed through one of the small abdominal incisions. If the spleen is too large to be removed in one piece, it will be broken up in the bag and removed as smaller pieces. At the end of the surgery, carbon dioxide gas is removed. The small incisions are closed with suture, the skin is cleaned and the incisions are covered with a small dressing.
What are the Risks of Having Laparoscopic Splenectomy?
Splenectomy, either open or laparosocopic, is a safe procedure. 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. If there is an accessory (extra) spleen and it is not seen during the original laparoscopic procedure, a return to surgery may be necessary to remove it. You and your surgeon should discuss the potential complications in more detail.
What Happens if Surgery Cannot be Performed by Laparoscopic Technique?
Sometimes it is not possible for the surgeon to use the laparoscopic technique because it may be difficult to see or handle the organs safely. 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. Open splenectomy would require hospitalization for 3-7 days and 2-6 weeks for a full recovery. 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.
What can I Expect to Happen Before Having Laparoscopic Surgery?
- A thorough medical evaluation will be made by your physician. Several diagnostic tests may be needed. You may have blood tests, an electrocardiogram (EKG) or chest x-ray to check your heart and lungs.
- You may be given prophylactic vaccines prior to surgery.
- You may be asked to donate 2 units of your own blood to be given postoperatively if necessary. If you have a deficiency in platelets (a clotting component of the blood), your physician may reserve platelet units in the blood bank for you or give you corticosteroids or gamma globulin to increase your own platelets.
- Taking no food or liquids after midnight the night before the surgery. This decreases the risk of vomiting after you receive anesthesia.
- If taking medications daily, discuss the need to take them with your doctor prior to the morning of surgery (with a sip of water). If taking blood thinners, aspirin or arthritis medications, discuss the proper time to stop these medications before the surgery date (day).
- Speak with the anesthesiologist before surgery to discuss anesthesia and pain management postoperatively.
- Arrange for someone to drive you to the hospital the day of surgery and take you home when you are discharged from the hospital.
What can I Expect the Day of Surgery?
- Arrive at the hospital on the day and time you are instructed.
- Sign a written consent authorizing your physician to perform the surgery.
- Receive a small needle/catheter in you vein to provide medication before, during and after your surgery.
- Receive preoperative medications as necessary.
- Undergo general anesthesia (asleep) prior to your surgery.
- Understand the procedure may take several hours.
- Going to the recovery room after surgery and having your blood pressure, pulse, and respirations closely monitored until you are fully awake.
- Going back to your room.
- Staying in the hospital the night of surgery and additional days as needed.
What can I Expect After Surgery?
- Engage in light activity at home.
- Experience mild to moderate post operative pain and having pain medication available as needed. There is usually some shoulder pain secondary to the insufflation of the abdomen.
- Having a modified diet starting with liquids and followed by gradually taking solid foods as you tolerate them.
- Resume normal activities such as showering, stair climbing, working, lifting, driving and having sexual intercourse after discussing these with your physician.
- Call and schedule a follow-up appointment within one to two weeks after surgery. Schedule any additional follow-up appointments.
- Having any stitches removed depending upon the type your physician uses.
When Should I Call My Physician?
Make certain that you call your physician if you have any of the following symptoms:
- Significant shortness of breath or persistent cough
- Persistent fever over 101 degrees Fahrenheit
- Significant drainage from incisions
- Persistent chills
- Increased abdominal swelling or pain
- Prolonged soreness or no relief from prescribed pain medications
- Bleeding
- Persistent nausea or vomiting
If you have any questions about the need for laparoscopic splenectomy, alternatives, procedure cost, insurance or billing, physician training and experience, or have questions about surgery, you are encouraged to ask the office or hospital staff and your physician.
Written by:
Horatio Asbun, M.D.
Director of Minimally Invasive Surgery Programs
John Muir Health
Jacklyn J. Schuchardt, RN, MSN, CNOR
Clinical Nurse Specialist, Surgery
John Muir Medical Center-Walnut Creek Campus
Walnut Creek, California
Diane M.Graham, RN, MSN, CNOR
Perioperative Clinical Nurse Specialist, John Muir Medical Center-Concord Campus, Concord, CA
References
Hashizume, M. et al "Laparoscopic Splenectomy". The American Journal of Surgery, Vol. 167, June 1994, p 611-613.
Phillips, E.H. et al, "Laparoscopic Splenectomy". Surgical Endoscopy, June 1994, Vol. 137, p. 931-933.
Rege, R. et al, " Laparoscopic Splenectomy ." Laparoscopic Surgery, Vol. 76, No. 3, June 1996, p. 459-468.
Trias, M. et al, "Laparoscopic Splenectomy : Technical Aspects and Preliminary Results." Endoscopic Surgery, 1994, 2: 288-292.
Trias, M. et al, " Laparoscopic surgery for treatment of splenic disorders: an update". European Journal of Gastroenterology and Hepatology, 1997, Vol. 9, No. 8: 750-55.
Copyright © 2010 John Muir Health