LAPAROSCOPIC SPLENECTOMY

STEP BY STEP APPROACH

Dr. K. Sendhilkumar MS, DNB (Surg Gastro) FACS, FICSDr. Piyush Patwa DNB, FMAS, FIAGES

Case Report We present a case of 22 years young unmarried female

patient diagnosed to have Hereditary spherocytosis with Cholelithiasis who was on medical therapy for past few years. She was evaluated and referred for surgery by a haematologist.

Her Labs- Hb- 9.9 g/dl, MCH- 24.6 pg, MCHC- 33 g/dl, Platelet count- 3,34,000/mm3

USG and CT scan were suggestive of Massive splenomegaly with multiple gall bladder calculi.

The patient was vaccinated to decrease the risk of overwhelming postsplenectomy Infection (OPSI) by organisms such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis. All three vaccines were given to patient and she was also educated prior to discharge on the risk of OPSI & her immunocompromised state.

Procedure Laparoscopic Splenectomy Anterior

approach The splenocolic ligament was dissected, followed by upward transection of the splenogastric ligament and short gastric using the harmonic scalpel. The splenic artery was identified along the upper margin of the pancreatic body and appropriately dissected. The arterial inflow was interrupted by applying two silk ties proximally and an endoclip to reduce spleen size and minimize blood loss during splenectomy.

The splenic veins were dissected and securely ligated with silk ties and endoclips.

The splenogastric ligament was transected starting from the upper pole, followed by transection of the splenocolic, splenorenal and splenophrenic ligaments.

Specimen retrieved out in toto through mini- Pfannenstiel incision.

Laparoscopic Cholecystectomy was also performed at the same time.

We present step by step self explanatory labeled pictures

of the Laparoscopic Splenectomy with surgical tip

& technique