1
|
Murshid MY, AlHawsah AO, AlSayed KT, Ansari FA. Isolated splenic lymphangioma in adulthood. J Surg Case Rep 2024; 2024:rjae411. [PMID: 38863957 PMCID: PMC11165307 DOI: 10.1093/jscr/rjae411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024] Open
Abstract
Isolated splenic lymphangiomas are rare benign lesions mostly seen in children are exceptionally rare in adults, often discovered incidentally due to their typically asymptomatic nature. This case report elaborates on the surgical excision of a rare splenic cystic lymphangioma in a 33-year-old woman, underscoring the diagnostic and therapeutic challenges these tumors pose. The patient's symptoms, abdominal pain and a palpable mass led to imaging through ultrasound and CT, which revealed a cystic splenic lesion. Total splenectomy was performed, revealing a large cystic mass, with pathological examination confirming a cystic lymphangioma. This case emphasizes the necessity of considering splenic lymphangiomas in adult patients presenting with splenic lesions. It also highlights the critical role of surgical interventions for definitive diagnosis and to prevent complications such as rupture and hemorrhage, thereby emphasizing on the complexity of managing rare splenic tumors.
Collapse
Affiliation(s)
- Mohsin Yahya Murshid
- Department of General Surgery, International Medical Center, P.O. Box 2172, Jeddah 21451, Saudi Arabia
| | - Atif Omar AlHawsah
- Department of General Surgery, Hera General Hospital, Al Madinah Al Munawarah Rd, Makkah 24227, Saudi Arabia
| | - Kadi T AlSayed
- Department of General Surgery, Hera General Hospital, Al Madinah Al Munawarah Rd, Makkah 24227, Saudi Arabia
| | - Farrukh Alim Ansari
- Department of General Surgery, Hera General Hospital, Al Madinah Al Munawarah Rd, Makkah 24227, Saudi Arabia
| |
Collapse
|
2
|
Daneshgar Rahbar M, Mousavi Mojab SZ. Enhanced U-Net with GridMask (EUGNet): A Novel Approach for Robotic Surgical Tool Segmentation. J Imaging 2023; 9:282. [PMID: 38132700 PMCID: PMC10744415 DOI: 10.3390/jimaging9120282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
This study proposed enhanced U-Net with GridMask (EUGNet) image augmentation techniques focused on pixel manipulation, emphasizing GridMask augmentation. This study introduces EUGNet, which incorporates GridMask augmentation to address U-Net's limitations. EUGNet features a deep contextual encoder, residual connections, class-balancing loss, adaptive feature fusion, GridMask augmentation module, efficient implementation, and multi-modal fusion. These innovations enhance segmentation accuracy and robustness, making it well-suited for medical image analysis. The GridMask algorithm is detailed, demonstrating its distinct approach to pixel elimination, enhancing model adaptability to occlusions and local features. A comprehensive dataset of robotic surgical scenarios and instruments is used for evaluation, showcasing the framework's robustness. Specifically, there are improvements of 1.6 percentage points in balanced accuracy for the foreground, 1.7 points in intersection over union (IoU), and 1.7 points in mean Dice similarity coefficient (DSC). These improvements are highly significant and have a substantial impact on inference speed. The inference speed, which is a critical factor in real-time applications, has seen a noteworthy reduction. It decreased from 0.163 milliseconds for the U-Net without GridMask to 0.097 milliseconds for the U-Net with GridMask.
Collapse
Affiliation(s)
- Mostafa Daneshgar Rahbar
- Department of Electrical and Computer Engineering, Lawrence Technological University, Southfield, MI 48075, USA
| | | |
Collapse
|
3
|
Laparoscopic Splenectomy According to Spleen Size: a 19 Years’ Experience Study of a Single Institution. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
4
|
Gonzalez-Urquijo M, Rodarte-Shade M, Gil-Galindo G. Splenic Primary Solid Tumors : Does a Preoperative Histopathology Diagnosis Really Matter? Am Surg 2020; 87:316-320. [PMID: 32936005 DOI: 10.1177/0003134820951480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The present study aims to present a case series of patients who underwent splenectomy for splenic primary solid tumors without preoperative histopathologic diagnosis. METHODS From 2013 to 2019, 12 patients underwent splenectomy for solid primary splenic tumors at 3 different academic medical centers. All electronic medical records were retrospectively reviewed. RESULTS Seven (58.3%) patients were women, and 5 (41.6%) were male. The median age was 48 years (range: 25-72 years). In 8 (66.6%) patients, a conventional approach was performed. In 2 (16.6%), a hand-assisted laparoscopic surgery procedure was completed, and in other 2 (16.6%) patients, a laparoscopic approach was auspiciously achieved. Median operative time was 135 minutes (range: 60-210 minutes), and median blood loss was 500 mL (range: 200-1500 mL). Procedure-related morbidity was found in 2 (16.6%) patients, and the mortality rate was 0%. The final histopathologic diagnosis was lymphoma in 5 (41.6%) patients, lymphangioma in 3 (25%) patients, hamartoma in 2 (16.6%) patients, angiosarcoma, and sclerosing angiomatoid nodular transformation (SANT) in 1 (8.3%) case each. CONCLUSION Splenectomy should be the treatment of choice when encountering a primary splenic tumor without the need for preoperative fine-needle aspiration biopsy, avoiding the complications this technique entails.
Collapse
Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernando Sepúlveda". Adolfo López Mateos, San Nicolás de los Garza, México
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernando Sepúlveda". Adolfo López Mateos, San Nicolás de los Garza, México
| | - Gerardo Gil-Galindo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernando Sepúlveda". Adolfo López Mateos, San Nicolás de los Garza, México
| |
Collapse
|
5
|
Aziret M, Koyun B, Karaman K, Sunu C, Karacan A, Öter V, Çelebi F, Ercan M, Bostancı EB. Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy. Turk J Surg 2020; 36:72-81. [PMID: 32637879 DOI: 10.5578/turkjsurg.4535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
Objectives Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum dissection technique. Material and Methods A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8). Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity. Results No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease, operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p <0.05) were higher in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to open surgery. Conclusion Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.
Collapse
Affiliation(s)
- Mehmet Aziret
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Bülent Koyun
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Kerem Karaman
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Cenk Sunu
- Clinic of Hematology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Alper Karacan
- Clinic of Radiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Volkan Öter
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Fehmi Çelebi
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Metin Ercan
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Erdal Birol Bostancı
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| |
Collapse
|
6
|
Szasz P, Ardestani A, Shoji BT, Brooks DC, Tavakkoli A. Predicting venous thrombosis in patients undergoing elective splenectomy. Surg Endosc 2019; 34:2191-2196. [PMID: 31359197 DOI: 10.1007/s00464-019-07007-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/19/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Venous thrombosis (VT) is an ongoing problem for patients undergoing elective splenectomy. There is limited data evaluating risk factors for VTs. An increase in platelet counts is commonly seen after splenectomy; however, there is a paucity of literature evaluating post-operative platelet counts as a risk factor for VTs in this patient cohort. The objective of this study was to determine the incidence of VT events and to use the platelet count as a predictor for VT development. METHODS A retrospective review was undertaken at Brigham Women's Hospital, evaluating elective splenectomy patients between 1997 and 2018. Descriptive statistics were utilized to determine the incidence of VTs. Receiver operator characteristic (ROC) curves were utilized to identify platelet counts that could predict VTs. RESULTS Five hundred and twenty splenectomies were included in the study of which 344 were completed in an open manner and 176 were done laparoscopically. The overall incidence of VT events was 6.7% (35/520), 6.1% (21/344) for open, and 8.0% (14/176) for laparoscopic approaches (p = 0.43). ROC curves demonstrated platelet counts to be a good predictor for the development of VTs with an area under the curve (AUC) of 0.77 (95% CI 0.69-0.86; p < 0.001) for all splenectomy patients, 0.70 (95% CI 0.59-0.81; p < 0.001) for those completed in an open manner, and 0.88 (95% CI 0.77-0.99; p < 0.001) for those done laparoscopically. The optimal platelet cutoff was found to be 545 for the overall splenectomy cohort, 457 for the open, and 659 for the laparoscopic cohorts. These platelet counts had a diagnostic accuracy that ranged from 61 to 86% and a negative predictive value (NPV) that ranged from 97 to 99%. CONCLUSION These results suggest platelet cutoffs that predict VTs. This information can be used to individualize prophylactic strategies.
Collapse
Affiliation(s)
- Peter Szasz
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA. .,Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, 75 Francis Street, ASBII-3rd Floor, Boston, MA, 02115, USA.
| | - Ali Ardestani
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, USA
| | - Brent T Shoji
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - David C Brooks
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ali Tavakkoli
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital, Boston, MA, 02115, USA
| |
Collapse
|
7
|
Preoperative Predictive Factors of Conversions in Laparoscopic Splenectomies. Surg Laparosc Endosc Percutan Tech 2018; 28:e63-e67. [PMID: 29672344 DOI: 10.1097/sle.0000000000000522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Presently, laparoscopic splenectomy (LS) is being performed for several indications in clinical practice. However, conversion to open surgery is occasionally required in some patients. We analyzed the intraoperative indications and potential preoperative predictors associated with conversion to open surgery in those presenting for LS. METHODS We reviewed 107 patients who underwent LS. We analyzed the surgical indications, spleen size, surgical procedure performed, operative time, rate of and indications for conversions, as well as postoperative complications. RESULTS Among the 15 patients (14.0%) who underwent conversion, the conversion was related to the occurrence of a splenic lymphoma in 10, severe bleeding in 3, a lack of anatomic definition in 1, and splenic candidiasis in 1 patient. A comparison between the results obtained in the initial 30 patients (LS performed during the learning curve) and those obtained in the remaining 77 patients, showed that conversions appeared to be related to the experience/expertise of the surgical team excluding patients with splenic malignancies. Conversion was not associated with a higher morbidity-mortality rate, but only a longer length of hospitalization. CONCLUSIONS LS is a gold standard procedure when performed by experienced and competent surgeons. However, careful patient selection is recommended before using the laparoscopic approach in those presenting with splenic malignancies.
Collapse
|
8
|
Kumar P, Kumar S, Husain N, Chandra A. Isolated cystic lymphangiomatosis of spleen in an adult: a diagnostic conundrum. BMJ Case Rep 2018; 2018:bcr-2017-223856. [PMID: 29622712 DOI: 10.1136/bcr-2017-223856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lymphangiomatosis is a rare developmental disorder characterised by diffuse proliferation of anastomosing lymphatic channels (lymphangiomas). It is believed to result from anomalous lymphatic development and usually presents in childhood. It typically occurs as a part of systemic lymphangiomatosis and isolated organ involvement is rare. Only nine cases of isolated cystic lymphangiomatosis of spleen have been reported between 1990 and 2010. Tuberculosis is a significant health problem in India and varied forms of this disease are seen in clinical practice. Isolated splenic tuberculosis, though a rare entity, has been described in the Indian population. We present a case of isolated splenic lymphangiomatosis in a 42-year-old woman that was initially misdiagnosed as splenic tuberculosis and was treated accordingly. Unresponsive to medical treatment, the patient underwent splenectomy and on histopathological examination, cystic lymphangiomatosis was diagnosed. The patient's symptoms resolved after surgery and she is doing well at a follow-up of 3 months.
Collapse
Affiliation(s)
- Pavan Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saket Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhijit Chandra
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
9
|
He M, Ouyang L, Wang S, Zheng M, Liu A. Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis. Neurosurg Focus 2016; 41:E7. [DOI: 10.3171/2016.5.focus1637] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion.
METHODS
A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.
RESULTS
Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25–0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8–23), operative time was shorter (mean difference [MD], −12.84; 95% CI −20.68 to −5.00; p = 0.001), and blood loss was less (MD −9.93, 95% CI −17.56 to −2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD −1.77, 95% CI −3.67 to 0.13; p = 0.07).
CONCLUSIONS
To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.
Collapse
|
10
|
Gracia-Calvo LA, Martín-Cuervo M, Jiménez J, Vieítez V, Argüelles D, Durán ME, Ezquerra J. Development of a technique for standing hand-assisted laparoscopic splenectomy in five horses. Aust Vet J 2015; 93:183-8. [PMID: 26010922 DOI: 10.1111/avj.12326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 10/04/2014] [Accepted: 10/16/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To develop an experimental standing hand-assisted laparoscopic splenectomy (HALS) technique, report the associated peri-operative complications and document the short-term surgical outcomes. METHODS AND RESULTS Five healthy 300-470 kg horses that underwent standing HALS. Spleens of different weights (2.25-7.0 kg) were removed using this technique. The main complication during surgery was difficulty sectioning the gastrosplenic ligament. The postoperative complications included adhesions of the colon to the nephrosplenic ligament stump and incisional discharge in two horses. CONCLUSIONS Standing HALS is a feasible experimental procedure for medium-sized horses, which avoids rib excision and general anaesthesia, but requires further development.
Collapse
Affiliation(s)
- L A Gracia-Calvo
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Extremadura, Cáceres, Spain
| | - M Martín-Cuervo
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Extremadura, Cáceres, Spain
| | - J Jiménez
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Extremadura, Cáceres, Spain
| | - V Vieítez
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Extremadura, Cáceres, Spain
| | - D Argüelles
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - M E Durán
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Extremadura, Cáceres, Spain
| | - J Ezquerra
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Extremadura, Cáceres, Spain
| |
Collapse
|
11
|
Srivastava P, Jaiman R, Srivastava U, Singhal S. Giant splenic lymphangiomatosis in adult: a diagnostic dilemma. Indian J Surg 2015; 77:137-9. [PMID: 25972674 DOI: 10.1007/s12262-014-1203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022] Open
Abstract
Cystic lymphangiomatosis of the spleen occurs secondary to developmental malformation of the lymphatic system. It is one of the rare entities generally seen in children. It is usually seen in children. We report a case of cystic lymphangiomatosis of the spleen occurring in an adult woman presenting with massive splenomegaly. Total splenectomy was considered to be the treatment of choice for making definitive diagnosis and to exclude the presence of malignancy or other causes of massive splenomegaly.
Collapse
Affiliation(s)
| | - Richa Jaiman
- Department of Surgery, S.N. Medical College, Agra, UP India
| | | | | |
Collapse
|
12
|
Schucht P, Banz V, Trochsler M, Iff S, Krähenbühl AK, Reinert M, Beck J, Raabe A, Candinas D, Kuhlen D, Mariani L. Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial. J Neurosurg 2015; 122:1058-67. [DOI: 10.3171/2014.9.jns132791] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
In ventriculoperitoneal (VP) shunt surgery, laparoscopic assistance can be used for placement of the peritoneal catheter. Until now, the efficacy of laparoscopic shunt placement has been investigated only in retrospective and nonrandomized prospective studies, which have reported decreased distal shunt dysfunction rates in patients undergoing laparascopic placement compared with mini-laparotomy cohorts. In this randomized controlled trial the authors compared rates of shunt failure in patients who underwent laparoscopic surgery for peritoneal catheter placement with rates in patients who underwent traditional mini-laparotomy.
METHODS
One hundred twenty patients scheduled for VP shunt surgery were randomized to laparoscopic surgery or mini-laparotomy for insertion of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication or failure within the first 12 months after surgery. Secondary endpoints were distal shunt failure, overall complication/ failure, duration of surgery and hospitalization, and morbidity.
RESULTS
The overall shunt complication/failure rate was 15% (9 of 60 cases) in the laparoscopic group and 18.3% (11 of 60 cases) in the mini-laparotomy group (p = 0.404). Patients in the laparoscopic group had no distal shunt failures; in contrast, 5 (8%) of 60 patients in the mini-laparotomy group experienced distal shunt failure (p = 0.029). Intraoperative complications occurred in 2 patients (both in the laparoscopic group), and abdominal pain led to catheter removal in 1 patient per group. Infections occurred in 1 patient in the laparoscopic group and 3 in the mini-laparotomy group. The mean durations of surgery and hospitalization were similar in the 2 groups.
CONCLUSIONS
While overall shunt failure rates were similar in the 2 groups, the use of laparoscopic shunt placement significantly reduced the rate of distal shunt failure compared with mini-laparotomy.
Collapse
Affiliation(s)
| | - Vanessa Banz
- 2Visceral Surgery and Medicine, Inselspital, University of Bern
| | | | - Samuel Iff
- 3Department of Clinical Research, Clinical Trials Unit Bern, University of Bern
| | | | - Michael Reinert
- 4Department of Neurosurgery, Ospedale Cantonale di Lugano, Switzerland; and
| | | | | | - Daniel Candinas
- 2Visceral Surgery and Medicine, Inselspital, University of Bern
| | - Dominique Kuhlen
- 5Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Luigi Mariani
- 6Department of Neurosurgery, University Hospital Basel
| |
Collapse
|
13
|
Abstract
Splenic lymphangioma is a rare malformation of the splenic lymphatic channels, mostly seen in children. It is characterized by the presence of cysts, resulting from increases in the size and number of thin-walled lymphatic vessels that are abnormally interconnected and dilated. The condition may be restricted to the spleen, but in most cases it involves multiple organs (systemic lymphangiomatosis). The clinical picture is variable; small lesions are often incidentally detected through imaging studies, while larger lesions can result in compression of organs, causing pain or rupture even after minor trauma. Therefore, splenic lymphangiomas should be considered in the differential diagnosis of splenomegaly or left upper quadrant pain even among adults and should be immediately treated with splenectomy; delay in the therapeutic intervention can lead to life-threatening complications.
Collapse
Affiliation(s)
- Ioannis Ioannidis
- From the Department of Pathology, University of South Alabama, Mobile
| | - Andrea G. Kahn
- From the Department of Pathology, University of South Alabama, Mobile
| |
Collapse
|
14
|
Fan Y, Wu SD, Kong J, Chao W. Single-incision laparoscopic splenectomy with conventional instruments: preliminary experience in consecutive patients and comparison to standard multiple-incision laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A 2014; 24:799-803. [PMID: 25376005 DOI: 10.1089/lap.2014.0213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AIM To study the feasibility and efficiency of transumbilical single-incision laparoscopic surgery splenectomy (SILS-Sp) using conventional instruments in consecutive patients and to compare outcomes of the procedure with those of standard multiple-incision laparoscopic splenectomy (MLS). PATIENTS AND METHODS A retrospective review was conducted to evaluate all SILS-Sp procedures performed by a single surgeon between March 2010 and January 2013. Additionally, patients who underwent MLS by other surgeons in the same surgical group during the same period were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed. RESULTS Thirteen patients underwent successful SILS-Sp during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 165 minutes. There was 7.7% morbidity and no mortality in the study group. Median length of stay was 8.8 days. Additionally, 12 patients who underwent MLS were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. For MLS, the median operative time was 158 minutes. There was 8.3% morbidity and no mortality in the group. Median length of stay was 8.3 days. SILS-Sp using conventional instruments was associated with reduced postoperative pain scores, but this did not reach statistical significance. The operative time, conversion rate, and length of stay were equivalent. The mortality, morbidity, and cost were also similar in the two groups. The umbilical incision of the single-incision group can be easily hidden in the umbilical fold with ideal cosmetic result. CONCLUSIONS SILS-Sp is feasible and efficient in an unselected patient population in the hands of an experienced laparoscopic surgeon. The single-incision technique is comparable to standard laparoscopic splenectomy in terms of operative time and perioperative outcomes. Ideal cosmetic effect may be its potential advantage.
Collapse
Affiliation(s)
- Ying Fan
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University , Shenyang City, Liaoning Province, China
| | | | | | | |
Collapse
|
15
|
Gianchandani Moorjani R, Marchena-Gomez J, Casimiro-Perez J, Roque-Castellano C, Ramirez-Felipe J. Morbidity- and mortality-related prognostic factors of nontraumatic splenectomies. Asian J Surg 2013; 37:73-9. [PMID: 24210540 DOI: 10.1016/j.asjsur.2013.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Splenectomy is a common surgical procedure, but few reports focus on nontraumatic splenectomies. The aim of this study was to determine the predictors of morbidity and mortality of patients submitted to elective nontraumatic splenectomy. METHODS A descriptive cross-sectional study of 152 consecutive, nonselected, nontraumatic patients operated on by splenectomy between 1996 and 2010 was carried out. Clinical, laboratory, and surgical data, histological findings, perioperative mortality, and postoperative complications according to Clavien-Dindo classification, were recorded. Factors related to morbidity and mortality were analyzed. RESULTS Of the 152 patients (89 male and 63 female; mean age 49.8 ± 17.8 years), 74 (48.7%) were operated on for malignant hematologic disorders, 44 for benign hematologic process, and 34 for other nonhematologic disorders. The spleen was enlarged in 95 patients (62.5%) and 78 patients (51.3%) had hypersplenism. The overall complications rate was 40.1%: Grades I and II in 27 cases (17.7%), and Grades III and IV in 23 patients (15.1%). Perioperative mortality was 7.2% (11 patients). In univariate analysis, significant negative predictors for morbidity were age (p = 0.004), anemia (p = 0.03), leukocytosis (p = 0.016), and blood transfusions (p < 0.001). In the multivariate analysis, only the need for blood transfusion remained as an independent prognostic factor (p = 0.001). Related to mortality, negative prognostic factors were age (p = 0.003), leukocytosis (p = 0.048), American Society of Anesthesiologists (ASA) score (p < 0.001), blood transfusion (p < 0.001), pleural effusion (p = 0.031), and pneumonia (p = 0.001). Pneumonia remained an independent prognostic factor of mortality (p = 0.024). CONCLUSION Blood loss is the most important prognostic factor for postoperative complications after nontraumatic splenectomies. Pneumonia is the main prognosis factor for perioperative mortality.
Collapse
Affiliation(s)
- Rajesh Gianchandani Moorjani
- Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
| | - Joaquin Marchena-Gomez
- Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Jose Casimiro-Perez
- Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Cristina Roque-Castellano
- Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Jose Ramirez-Felipe
- Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
16
|
Fan Y, Wu SD, Kong J, Su Y, Tian Y, Yu H. Feasibility and safety of single-incision laparoscopic splenectomy: a systematic review. J Surg Res 2013; 186:354-62. [PMID: 24135373 DOI: 10.1016/j.jss.2013.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/04/2013] [Accepted: 09/10/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic splenectomy (SILS-Sp). METHODS We conducted a systemic review of literature between 2009 and 2012 to retrieve all relevant articles. RESULTS A total of 29 studies with 105 patients undergoing SILS-Sp were reviewed. Fifteen studies used a commercially available single-port device. The range of body mass index was 14.7-41.4 kg/m(2). Six studies described combined operations including cholecystectomy (n = 8), mesh-pexy (n = 1), and pericardial devascularizaion (n = 1). The ranges of operative times and estimated blood losses were 28-420 min and 0-350 mL, respectively. Of 105 patients, three patients (2.9%) required additional ports, two patients (1.9%) were converted to open, and three patients (2.9%) to conventional multiport laparoscopic splenectomy (overall conversion rate, 4.8%). Postoperative bleeding occurred in two patients (1.9%) who both required reoperation. Overall mortality was 0% (0/105). The length of postoperative stay varied across reports (1-11 d). Among four comparative studies, one showed greater estimated blood loss and lower numeric pain rating scale score in the SILS-Sp group than in the multiport laparoscopic splenectomy group (206.25 ± 142.45 versus 111.11 ± 99.58 mL) and (3.81 ± 0.91 versus 4.56 ± 1.29), respectively. Another comparative study showed that SILS-Sp was associated with a shorter operative time (92.5 versus 172 min; P = 0.003), lower conversion rate, equivalent length of hospital stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements. CONCLUSIONS In early series of highly selected patients, SILS-Sp appears to be feasible and safe when performed by experienced laparoscopic surgeons. However, as an emerging operation, publication bias is a factor that should be considered before we can draw an objective conclusion.
Collapse
Affiliation(s)
- Ying Fan
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVE To evaluate 30-day postoperative outcomes in laparoscopic (LS) versus open splenectomy (OS). SUMMARY BACKGROUND DATA LS has generally been associated with lower rates of postoperative complications than OS. However, evidence mainly comes from small studies that failed to adjust for the confounding effects of the underlying indication or clinical condition that may have favored the use of one technique over the other. METHODS A retrospective cohort study of patients undergoing splenectomy in 2008 and 2009 using data from the American College of Surgeons National Surgical Quality Improvement Program database (n = 1781). Retrieved data included 30-day mortality and morbidity (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thromboembolism, and major bleeding outcomes), demographics, indication, and preoperative risk factors. We used multivariate logistic regression to assess the adjusted effect of the splenectomy technique on outcomes. RESULTS A total of 874 (49.1%) cases had LS and 907 (50.9%) had OS. After adjusting for all potential confounders including the indication and preoperative risk factors, LS was associated with decreased 30-day mortality [OR (odds ratio): 0.39, 95% CI: 0.18-0.84] and postoperative respiratory occurrences (OR: 0.46, 95% CI: 0.27-0.76), wound occurrences (OR: 0.37, 95% CI: 0.11-0.79), and sepsis (OR: 0.52, 95% CI: 0.26-0.89) when compared with OS. Patients who underwent LS also had a significantly shorter total length of hospital stay and were less likely to receive intraoperative transfusions compared with patients who underwent OS. CONCLUSIONS LS is associated with more favorable postoperative outcomes than OS, irrespective of the indication for splenectomy or the patient's clinical status.
Collapse
|
18
|
Bo W, He-Shui W, Guo-Bin W, Kai-Xiong T. Laparoscopy splenectomy for massive splenomegaly. J INVEST SURG 2013; 26:154-7. [PMID: 23617259 DOI: 10.3109/08941939.2012.691604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study is aimed to evaluate the feasibility of laparoscopic splenectomy (LS) for massive splenomegaly in patients with hypersplenism secondary to portal hypertension and liver cirrhosis. METHOD A retrospective study of adult patients was conducted for splenectomy occurring from January 2006 to December 2010. We have performed the surgical procedures of splenectomy in 80 patients who were suffering from splenomegaly or hypersplenism secondary to portal hypertension and liver cirrhosis, among whom 40 patients underwent LS and another 40 patients received open surgery (OS). RESULTS Among the patients who had undergone LS, 2 patients were converted to OS and the other 38 patients underwent complete LS. The operation time, intraoperative blood loss, and the length of stay in LS group and OS group were 100-200 min (mean: 150 ± 30 min) vs. 120-210 min (mean: 100 ± 30 min), 50-1,000 ml (mean: 150 ± 110 ml) vs. 60-900 ml (mean: 140 ± 50 ml) and 4-9 days (mean: 6.1 ± 2.2 days) vs. 8-14 days (mean: 11.3 ± 2.3 days), respectively. No deaths occurred in the two groups, and there are no significant differences between the two groups in terms of estimated blood loss, complications, length of stay, and operating time. CONCLUSION LS for treatment of massive splenomegaly is a feasible, effective, and safe surgical technique. Hypersplenism secondary to portal hypertension and liver cirrhosis are not supposed to be considered absolute contraindications to LS.
Collapse
Affiliation(s)
- Wang Bo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | | | | |
Collapse
|
19
|
Bai YN, Jiang H, Prasoon P. A meta-analysis of perioperative outcomes of laparoscopic splenectomy for hematological disorders. World J Surg 2013; 36:2349-58. [PMID: 22760851 DOI: 10.1007/s00268-012-1680-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Due to changes in surgical trends, laparoscopic splenectomy (LS) has become the standard approach for most splenectomies performed for hematological disorders, barring any contraindications. The perioperative outcomes of LS for this indication have not been updated for several years. Controversy still surrounds whether LS should be performed for massive splenomegaly. The purpose of this meta-analysis was to evaluate the perioperative outcomes of laparoscopic splenectomy for hematological disorders. METHODS Literature searches were conducted to identify studies comparing the perioperative outcomes of the laparoscopic and open approaches for hematological disorders. The results were pooled by using standard meta-analysis methods. RESULTS Thirty-eight studies with a total of 2,914 patients comparing LS to open splenectomy (OS) for hematological disorders were identified. Mortality was low in both groups. The pooled complications of the LS group were significantly fewer than those of the OS group (-0.11, p < 0.001), and the NNT was 9 (95 % confidence interval, 6-20). For massive spleens, a similar result was observed (-0.12, p = 0.009). Accessory spleen resection and blood loss also were comparable between the two approaches. Additionally, LS was associated with longer operative times (57.38 min, p < 0.00001) and shorter hospital stays (2.48 days, p < 0.00001). CONCLUSIONS LS is preferred compared to OS, based on lower complication rates and better handling of comorbid conditions. LS is associated with shorter hospital stays but longer operative times. We conclude that LS may be considered an acceptable option even in cases of a massive spleen. To strengthen the clinical evidence, more high-quality clinical trials on different issues are necessary.
Collapse
Affiliation(s)
- Yan-Nan Bai
- Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | | | | |
Collapse
|
20
|
George Verghese B, Kalvehalli Kashinath S, Kanth RR. Lymphangioma of the Spleen—A Rare Tumor Rarely seen
in an Adult: A Case Report and a Comprehensive
Literature Review. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
21
|
Abstract
BACKGROUND Some areas of laparoscopic splenectomy (LS), such as the approach to splenic pedicle dissection, remain controversial. Here we recommend a technique for dissecting the secondary splenic pedicle vessels on the basis of analysis of retrospective data. STUDY DESIGN A retrospective review (April 2006 to October 2011) of databases at 2 institutions identified 136 patients who had undergone LS. In 34 patients with massive splenomegaly, primary splenic pedicle dissection technique (PSPD) had been used in 19 patients and secondary splenic pedicle dissection technique (SSPD) had been used in 15 patients. In 102 patients with normal-sized spleen or moderate splenomegaly, PSPD had been used in 56 patients and SSPD in 46 patients. We compared perioperative and follow-up data. RESULTS Laparoscopic splenectomy was completed in 128 patients. In the massive splenomegaly group, the conversion rate was 5.3% for PSPD and 33.3% for SSPD, the complication rate was 42.1% vs 20%, hospital stay was 3.2 ± 2.0 days vs 7.5 ± 3.5 days, and transfusion requirement was 1.1 ± 1.2 U vs 3.2 ± 0.9 U, respectively. However, in the normal or moderate splenomegaly group, except for complications, there were no significant differences between PSPD and SSPD techniques in perioperative findings. In the 2 groups, there were significant differences between the PSPD and SSPD techniques in pancreatic leakage (15.8% vs 0 and 8.9% vs 0, respectively) and postoperative fever (15.8% vs 6.7% and 10.7% vs 2.2%, respectively). CONCLUSIONS Secondary splenic pedicle dissection can decrease the incidence of splenic fever and pancreatic leakage and is a valuable technique for LS for normal-sized spleen or moderate splenomegaly. It is not a safe procedure for massive splenomegaly because of the high conversion rate.
Collapse
|
22
|
|
23
|
Surgical treatment possibilities of splenic neoplasms - literature review. POLISH JOURNAL OF SURGERY 2012; 84:219-24. [PMID: 22698661 DOI: 10.2478/v10035-012-0036-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Lemke J, Scheele J, Juchems M, Henne-Bruns D, Brockschmidt C. Laparoscopic splenectomy of a wandering spleen with coincidental enormous splenomegaly. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2012; 1:Doc14. [PMID: 26504696 PMCID: PMC4582471 DOI: 10.3205/iprs000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ectopy of the spleen also referred to as wandering spleen is a rare condition and preferentially treated by laparoscopic splenopexy. However, in complicated cases with torsion and consecutive infarction of the spleen splenectomy is required. Performing the splenectomy of a wandering spleen laparoscopically has already been reported as a save therapeutic option. However, open splenectomy is usually preferred in case of massive splenomegaly for both, wandering and regular localized spleen. In this case report we describe a laparoscopic technique as alternative for conventional splenectomy in the case of a huge wandering spleen.
Collapse
Affiliation(s)
- Johannes Lemke
- Clinic of General and Visceral Surgery, University Hospital Ulm, Germany
| | - Jan Scheele
- Clinic of General and Visceral Surgery, University Hospital Ulm, Germany
| | - Markus Juchems
- Clinic of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Doris Henne-Bruns
- Clinic of General and Visceral Surgery, University Hospital Ulm, Germany
| | - Claas Brockschmidt
- Clinic of General and Visceral Surgery, University Hospital Ulm, Germany
| |
Collapse
|
25
|
Collard F, Nadeau ME, Carmel ÉN. Laparoscopic Splenectomy for Treatment of Splenic Hemangiosarcoma in a Dog. Vet Surg 2010; 39:870-2. [DOI: 10.1111/j.1532-950x.2010.00721.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
26
|
Patti R, Iannitto E, Di Vita G. Splenic lymphangiomatosis showing rapid growth during lactation: A case report. World J Gastroenterol 2010; 16:1155-7. [PMID: 20205289 PMCID: PMC2835795 DOI: 10.3748/wjg.v16.i9.1155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Splenic lymphangiomatosis is a very rare condition that, from 1990 to date, has been described only nine times. In the present report, we describe the first case of splenic lymphangiomatosis with rapid growth during lactation in a 35-year-old woman. We also underline the difficultly in making an accurate preoperative diagnosis, despite more modern imaging techniques. Total splenectomy was considered to be the treatment needed, both to make a definitive diagnosis and to exclude the presence of malignancy.
Collapse
|
27
|
|