1
|
Namikawa T, Araki K, Utsunomiya M, Yokota K, Munekage M, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K, Seo S. Laparoscopic partial splenectomy in a patient with splenic hemangioma after distal gastrectomy for a neuroendocrine tumor. Clin J Gastroenterol 2024; 17:29-33. [PMID: 37805948 DOI: 10.1007/s12328-023-01868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
Herein, we report the case of a patient with splenic hemangioma after distal gastrectomy who was treated with laparoscopic partial splenectomy. A 64-year-old woman previously underwent laparoscopic distal gastrectomy with regional lymph-node dissection for a gastric neuroendocrine tumor (G3) with venous infiltration and no lymph-node metastases. Periodic follow-up abdominal computed tomography revealed a well-defined, heterogeneous mass in the lower pole of the spleen 5 years after the operation, which grew from 12 to 19 mm 1 year later. A laparoscopic partial splenectomy was planned. During surgery, a smooth-surfaced mass with a lighter color than that of the surrounding area was observed at the lower pole of the spleen. The inferior polar branch of the splenic artery was transected, and the ischemic area of the lower pole of the spleen, where the tumor was present, was confirmed. First, the line used to perform splenic transection was determined using soft coagulation. The splenic parenchyma was then gradually transected using a vessel-sealing device system, and partial splenectomy was possible with almost no bleeding. The patient was discharged on postoperative day 8 without any complications. Pathological examination revealed a hemangioma without any malignant findings. Laparoscopic partial splenectomy is a safe and useful procedure that can be performed, considering the tumor size and location.
Collapse
Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Oko-Cho, 783-8505, Japan.
| | - Kohei Araki
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Oko-Cho, 783-8505, Japan
| | - Masato Utsunomiya
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Oko-Cho, 783-8505, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Oko-Cho, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Oko-Cho, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Oko-Cho, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Operating Room Management, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
| | - Kazuhiro Hanazaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Satoru Seo
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Oko-Cho, 783-8505, Japan
| |
Collapse
|
2
|
Fedele S, Bizzoca C, Aquilino F, Vincenti L. Laparoscopic partial splenectomy for symptomatic benign cystic lesions: technical notes. Updates Surg 2022; 74:1153-1156. [PMID: 35149968 DOI: 10.1007/s13304-021-01210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to explore the feasibility of laparoscopic partial splenectomy in patients with symptomatic benign lesions. During the period from April 2017 to February 2020, a single surgeon performed 7 LPS for benign lesions. As primary endpoint, we retrospectively analyzed the patient's short-term outcome and the operative results. As secondary endpoints, we considered 6-month follow-up. Laparoscopic partial splenectomy was performed successfully in all cases, with no major complications. Thirty-day mortality was nil. No post-operative transfusions were required and the median hospital stay was 4 (range 3-5) days. The median operative time was 110 (range 75-140) min and there was neither conversion to open surgery nor need for total splenectomy. Mean blood loss was 135.7 ± 103.6 ml and no intraoperative blood transfusions were necessary. All patients recovered successfully, with significant decrease of Ca 19.9 (98.22 ± 118.10 U/mL vs. 4.78 ± 3.35 U/mL, P = 0.015) and normal platelet count (215.7 × 103 ± 42.2 × 103 per µL vs. 236.0 × 103 ± 58.3 × 103 per µL, P = 0.285) at 1-month follow-up. No cases of recurrence were detected during the 6-month follow-up. Laparoscopic splenic resection for benign lesions is a challenging but feasible procedure. This technique combines the advantages of both mini-invasive surgery and spleen preservation.
Collapse
Affiliation(s)
- Salvatore Fedele
- General Surgery Unit, National Institute of Gastroenterology IRCCS Saverio de Bellis, Research Hospital, via Turi 27, Castellana Grotte, 70013, Bari, Italy.
| | - Cinzia Bizzoca
- Department of General Surgery "Ospedaliera", Polyclinic Hospital of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Fabrizio Aquilino
- General Surgery Unit, National Institute of Gastroenterology IRCCS Saverio de Bellis, Research Hospital, via Turi 27, Castellana Grotte, 70013, Bari, Italy
| | - Leonardo Vincenti
- Department of General Surgery "Ospedaliera", Polyclinic Hospital of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| |
Collapse
|
3
|
Schiavetti A, Pecorella I, Masselli G, Ceccanti S, Cozzi DA. Splenic myopericytoma/glomangiopericytoma in an adolescent male. Pediatr Blood Cancer 2022; 69:e29406. [PMID: 34665513 DOI: 10.1002/pbc.29406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Amalia Schiavetti
- Department of Maternal and Urological Sciences - Pediatric Oncology Unit, "Sapienza" University of Rome, Rome, Italy
| | - Irene Pecorella
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, Rome, Italy
| | - Gabriele Masselli
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Ceccanti
- Department of Maternal and Urological Sciences - Pediatric Oncology Unit, "Sapienza" University of Rome, Rome, Italy
| | - Denis A Cozzi
- Department of Maternal and Urological Sciences - Pediatric Oncology Unit, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
4
|
Malgras B, Najah H, Dohan A, Barat M, Soyer P. Diagnosis and treatment of focal splenic lesions. J Visc Surg 2022; 159:121-135. [DOI: 10.1016/j.jviscsurg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Lazaar H, Malki Y, Bouhout T, Serji B, El Harroudi T. Partial Splenectomy for a Sizeable Cavernous Hemangioma: Case Report and a Review of the Literature. Cureus 2021; 13:e12882. [PMID: 33633911 PMCID: PMC7899278 DOI: 10.7759/cureus.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The recent awareness of the spleen's important role, especially its immune function, has fundamentally changed the management of splenic diseases, promoting the splenic preserving surgery, and protecting from the significant risk of total splenectomy: overwhelming post-splenectomy sepsis. Partial splenectomy is a safe and feasible technique that offers, according to the literature, the same results of a total approach, either in achieving hematological benefits in congenital hemolytic anemia, or treating the focal splenic lesion such as hemangioma, while preserving the immune function.
Collapse
Affiliation(s)
- Hatim Lazaar
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Yosra Malki
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tariq Bouhout
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| |
Collapse
|
6
|
Romboli A, Annicchiarico A, Morini A, Castro Ruiz C, Pagliai L, Montali F, Costi R. Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases. J Laparoendosc Adv Surg Tech A 2021; 31:1130-1142. [PMID: 33471586 DOI: 10.1089/lap.2020.0769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.
Collapse
Affiliation(s)
- Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Alfredo Annicchiarico
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Andrea Morini
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Carolina Castro Ruiz
- Unità Operativa di Chirurgia Generale, Ospedale Civile di Guastalla, Guastalla, Italia
| | - Lorenzo Pagliai
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Filippo Montali
- Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| |
Collapse
|
7
|
Bing Y, Sadula A, Xiu D, Yuan C. Laparoscopic middle segment splenectomy for central splenic hemangioma: A case report. Int J Surg Case Rep 2020; 77:925-929. [PMID: 33277219 PMCID: PMC7775971 DOI: 10.1016/j.ijscr.2020.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Laparoscopic middle segment splenectomy for central splenic hemangioma is a new technique. Laparoscopic middle segment splenectomy for central splenic hemangioma is very useful for some selected patients. In patients with splenic artery bifurcation point far from the splenic hilus parenchyma and in those cases where the blood supply of the upper and lower pole splenic segments can be ensured, when the splenic tumor is resected, performing LPS and retaining some upper and lower splenic segments is possible to ensure sufficient residual spleen.
Introduction Laparoscopic surgery plays an important role in the treatment of splenichematologic pathologies and solid lesions. Splenic hemangioma is the most common benign tumor of the spleen. In patients with benign splenic space-occupying lesions, laparoscopic partial splenectomy (LPS) has a lower incidence of postoperative complications than laparoscopic total splenectomy (LTS). Currently, no uniform standard for the indication of LPS is available. Presentation of case Herein, we report a case of hemangioma in a 23-year-old woman treated with LPS. After multidisciplinary evaluation, laparoscopic splenectomy was indicated in this case; upon evaluating the age of the patient and the affected spleen portion, a middle segment splenectomy was proposed, with preservation of the upper and lower pole. The intraoperative frozen section of the specimen was negative for malignancies. Discussion Surgery remains the first choice in the treatment of solid lesions of the spleen. In this case, the volume of splenic hemangioma was large and accumulated in the upper and lower segments of the spleen. After the middle branch of splenic artery was cut off, the tumor was completely contained in the middle of upper and lower ischemic lines splenic segment. We think that the central type of benign splenic space occupying is not an absolute contraindication of LPS. For the patients whose splenic artery bifurcation point is far from the splenic hilus parenchyma and in those cases where the blood supply of the upper and lower poles of the splenic segments can be ensured, when the splenic tumor is resected, performing LPS and retaining some parts of the upper and lower splenic segments is possible to ensure sufficient residual spleen.
Collapse
Affiliation(s)
- Yuntao Bing
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China
| | - Abuduhaibaier Sadula
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China.
| | - Chunhui Yuan
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China.
| |
Collapse
|
8
|
Abstract
BACKGROUND Laparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits. METHODS We conducted a comprehensive review for the years 1995-2018 to retrieve all relevant articles. RESULTS A total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50-225 min and 0-1200 ml, respectively. There are eight patients need blood transfusion in 231 patients with available data. The conversion rate was 3.6% (9/252). Overall, 27 patients (10.7%;27/252) developed postoperative or intraoperative complications. Overall mortality was 0% (0/252). The length of postoperative stay (POS) varied (1-11 days). Among four comparative studies, one showed LPS could reduce POS than laparoscopic total splenectomy (LTS) (LTS 5.4 ± 1.8 days, LPS 4.2 ± 0.8 days, p = 0.027) and complications (pleural effusion (LTS 9/22, LPS 0/15, p = 0.005), splenic vein thrombosis (LTS 10/22, LPS 0/15, p = 0.002)). Another comparative study showed LPS may benefit emergency patients. However, one comparative study showed LPS was associated with more pain, longer time to oral intake, and longer POS in children with hereditary spherocytosis. The fourth comparative study showed robotic subtotal splenectomy was comparable to laparoscopy in terms of POS and complication. The main benefits were lower blood loss, vascular dissection time, and a better evaluation of splenic remnant volume. CONCLUSIONS In early series of highly selected patients, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons.
Collapse
|
9
|
Costi R, Castro Ruiz C, Romboli A, Wind P, Violi V, Zarzavadjian Le Bian A. Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases. J Pediatr Surg 2019; 54:1527-1538. [PMID: 30665627 DOI: 10.1016/j.jpedsurg.2018.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset. METHODS A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy. RESULTS Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients. CONCLUSIONS Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia.
| | | | - Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Philippe Wind
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France
| | - Vincenzo Violi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris "Descartes", Paris, France
| |
Collapse
|
10
|
Laparoscopic Partial Splenectomy: A Safe and Feasible Treatment for Splenic Benign Lesions. Surg Laparosc Endosc Percutan Tech 2019; 28:287-290. [PMID: 30180141 DOI: 10.1097/sle.0000000000000568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to explore the safety and feasibility of laparoscopic partial splenectomy in treating splenic benign lesions (SBL). MATERIALS AND METHODS A total of 16 SBL patients clearly diagnosed before surgery (8 cases of splenic cysts, 5 cases of splenic lymphangioma, and 3 cases of splenic hemangioma) underwent 2D or 3D laparoscopic partial splenectomy from October 2013 to August 2016. The diameters of the SBL were 5 to 17 cm with an average of 8.7 cm; 12 cases were located in the upper pole of the spleen, and 4 cases were located in the lower pole of the spleen. RESULTS All 16 patients successfully completed laparoscopic partial splenectomy, and no patients required conversion to an open operation. There were 3 cases of resection using the 3D laparoscope. There were 14 cases of resection of half of the spleen and 2 cases of partial resection of the lower spleen. The operation time was 110 to 195 minutes with an average time of 157 minutes. The amount of intraoperative blood loss was 80 to 200 mL, and no patients required blood transfusion. The postoperative abdominal drainage time was 3 to 5 days, and no abdominal bleeding, pancreatic leakage, subphrenic infection, or other complications occurred; the postoperative hospital stay lasted 5 to 6 days. CONCLUSIONS Laparoscopic partial splenectomy is safe and feasible for the treatment of splenic benign lesions.
Collapse
|
11
|
Serra F, Sorrentino L, Cabry F, Biondini D, Ceccarelli PL, Campanelli M, Gelmini R. First case of laparoscopic partial splenectomy in a child with hamartoma: Case report and review of the literature. Int J Surg Case Rep 2018; 53:140-143. [PMID: 30396124 PMCID: PMC6216043 DOI: 10.1016/j.ijscr.2018.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION To date, laparoscopic surgery has played a key role in the treatment of not only splenic hematologic pathologies but also solid ones. Hamartoma is a rare disease; only twenty percent of them are of pediatric relevance; it is a benign tumor, but radiological features never allow proper differentiation from malignant neoplasms. In children, hamartoma may be associated with other morbid conditions, such as sickle cell disease or other hematological alterations. PRESENTATION OF THE CASE We report a case of hamartoma in a 7-year-old child treated with partial laparoscopic splenectomy. After a multidisciplinary evaluation, the indication of laparoscopic splenectomy was decided; upon evaluating the age of the patient and the affected spleen portion, a partial splenectomy was proposed. The histological examination during surgery was performed to exclude any form of malignancy. The intraoperative frozen section of the specimen was negative for malignancies, and a partial splenectomy was performed. DISCUSSION Surgery remains the first choice in the definitive treatment of solid lesions of the spleen; minimally invasive technique, namely, laparoscopy, has set itself as the technique of choice for surgical treatment. In this case, the possibility of obtaining an intraoperative pathological diagnosis by frozen section of the specimen, confirming the benign nature of the lesion, allowed the surgeon to decide in favor of a laparoscopic partial splenectomy. CONCLUSION Partial laparoscopic splenectomy can be considered a safe, effective and reproducible alternative in patients suffering from benign solid diseases, safeguarding the hematological functions of the organ itself in pediatric age.
Collapse
Affiliation(s)
- Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100 Modena, Italy.
| | - Lorena Sorrentino
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100 Modena, Italy.
| | - Francesca Cabry
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100 Modena, Italy.
| | - Diego Biondini
- Department of Pediatric Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100 Modena, Italy.
| | - Pier Luca Ceccarelli
- Department of Pediatric Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100 Modena, Italy.
| | - Michela Campanelli
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100 Modena, Italy.
| | - Roberta Gelmini
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100 Modena, Italy.
| |
Collapse
|
12
|
Esposito F, Noviello A, Moles N, Cantore N, Baiamonte M, Coppola Bottazzi E, Miro A, Crafa F. Partial splenectomy: A case series and systematic review of the literature. Ann Hepatobiliary Pancreat Surg 2018; 22:116-127. [PMID: 29896572 PMCID: PMC5981141 DOI: 10.14701/ahbps.2018.22.2.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/08/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023] Open
Abstract
Backgrounds/Aims Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches. Methods Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients. Results Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5–50%) and in 3% of cases (range, 7–10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5–25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%). Conclusions The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.
Collapse
Affiliation(s)
- Francesco Esposito
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Adele Noviello
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Nicola Moles
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Nicola Cantore
- Department of Hematology and Stem Cell Transplantation, S.G. Moscati Hospital, Avellino, Italy
| | - Mario Baiamonte
- Department of General and Emergency Surgery, Civico Hospital, Palermo, Italy
| | | | - Antonio Miro
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Francesco Crafa
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| |
Collapse
|
13
|
Ramia JM, de la Plaza Llamas R, López-Marcano AJ, Valenzuela Torres JDC, García Gil JM. Laparoscopic partial splenectomy for a splenic epidermoid cyst. Cir Esp 2017; 95:613-615. [PMID: 28410628 DOI: 10.1016/j.ciresp.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/05/2017] [Accepted: 03/07/2017] [Indexed: 02/07/2023]
Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Roberto de la Plaza Llamas
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Aylhin Joana López-Marcano
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José Del Carmen Valenzuela Torres
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José Manuel García Gil
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| |
Collapse
|
14
|
Wang L, Xu J, Li F, Zhan H, Liu H, Chen W, Hu S. Partial Splenectomy is Superior to Total Splenectomy for Selected Patients with Hemangiomas or Cysts. World J Surg 2017; 41:1281-1286. [PMID: 28058472 DOI: 10.1007/s00268-016-3794-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The superiority of partial splenectomy (PS) as a treatment for benign tumors has not well been confirmed. This study aimed to identify the short- and long-term outcomes of PS, to compare laparoscopic and laparotomic PS, and to demonstrate whether the effects of PS are superior to that of total splenectomy (TS). METHODS Patients with either a hemangioma or cyst who underwent PS or TS from 2009 to 2015 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed. RESULTS A total of 17 patients underwent PS were collected, including 2 men and 15 women with a mean age of 43.9 ± 11.3 years old. Patients who underwent laparoscopic PS (9 cases) had a longer operative time and shorter postoperative hospital stay than those who underwent laparotomy (8 cases). Compared with TS (22 cases), PS significantly decreased the incidence of thrombocytosis, shortened time until drainage removal, and shortened postoperative hospital stay. After an average follow-up of 34.8 months, patients who underwent TS showed a higher incidence of thrombocytosis and splenic vein thrombosis compared with patients underwent PS. CONCLUSIONS PS is technically feasible and provides favorable short- and long-term outcomes for selected patients with either a hemangioma or cyst compared with TS. Laparoscopic PS shows lower morbidity and equal therapeutic efficacy compared with laparotomic PS and can be widely performed.
Collapse
Affiliation(s)
- Lei Wang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Jianwei Xu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Feng Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Hanxiang Zhan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Han Liu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Wei Chen
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
15
|
Fernández-López AJ, Candel-Arenas M, González-Valverde FM, Luján-Martínez D, Medina-Manuel E, Albarracín Marín-Blázquez A. [Laparoscopic cleavage in splenic symptomatic cyst]. CIR CIR 2016; 85 Suppl 1:26-29. [PMID: 28043643 DOI: 10.1016/j.circir.2016.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/05/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Splenic cysts are rare diseases that are diagnosed incidentally during imaging studies. When cysts are recognized, surgical treatment is recommended adapted to the particular case, depending on the size and location of the cyst and the age of the patient in order to avoid dangerous complications such as spleen rupture or cyst infection with abscess. CLINICAL CASE We report 2patients with symptomatic splenic epidermoid cyst treated by laparoscopic cleavage. CONCLUSIONS Laparoscopic cleavage is a surgical option for splenic cyst, with the goal of reducing postoperative complications while preserving splenic function.
Collapse
Affiliation(s)
| | - Marifé Candel-Arenas
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | | | - Delia Luján-Martínez
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | - Esther Medina-Manuel
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | | |
Collapse
|
16
|
Cai H, An Y, Wu D, Chen X, Zhang Y, Zhu F, Jiang Y, Sun D. Laparoscopic Partial Splenectomy: A Preferred Method for Select Patients. J Laparoendosc Adv Surg Tech A 2016; 26:1010-1014. [PMID: 27467747 DOI: 10.1089/lap.2016.0150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to explore the feasibility and safety of laparoscopic partial splenectomy (LPS) using a harmonic scalpel (HS) combined with bipolar coagulation. MATERIALS AND METHODS Using HS and bipolar coagulation technology, 18 patients suffering from splenic cystic neoplasm were treated with LPS between January 2010 and December 2014, and their clinical data were analyzed retrospectively. RESULTS LPS was performed successfully without conversion to open surgery in all cases. The mean intra-operative blood loss was 75.8 ± 33.5 mL, and the mean operation time was 54.3 ± 16.6 minutes (range, 48-82 minutes). No cases of postoperative bleeding, infection, or pancreatic fistula occurred. No patient required total splenectomy. The mean hospital stay was 6.6 ± 3.2 days, and the median postoperative follow-up was 19.8 months (range, 5-60 months). All patients recovered successfully, with normal complete blood counts and without any recurrence on follow-up. CONCLUSIONS LPS is a safe and feasible operation for selected patients. Combined use of an HS and bipolar coagulation can shorten the operation time, reduce blood loss, and improve the safety of the operation.
Collapse
Affiliation(s)
- HuiHua Cai
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| | - Yong An
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| | - Di Wu
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| | - XueMin Chen
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| | - Yue Zhang
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| | - Feng Zhu
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| | - Yong Jiang
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| | - DongLin Sun
- Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Hospital Affiliated to Soochow University , Changzhou, China
| |
Collapse
|
17
|
Matsui T, Matsubayashi H, Sugiura T, Sasaki K, Ito H, Hotta K, Imai K, Tanaka M, Kakushima N, Ono H. A Splenic Epithelial Cyst: Increased Size, Exacerbation of Symptoms, and Elevated Levels of Serum Carcinogenic Antigen 19-9 after 6-year Follow-up. Intern Med 2016; 55:2629-34. [PMID: 27629958 DOI: 10.2169/internalmedicine.55.6970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old man, who had presented with a large cyst between the pancreatic tail and splenic hilum 6 years previously, was referred to our hospital with exacerbation of abdominal distention. Computed tomography revealed a well-demarcated, unilocular cyst, with a beak sign for the pancreas, without wall thickening or nodules suggestive of a non-neoplastic cyst. Compared with 6 years previously, the cyst had increased in size from 14.7 cm to 19.5 cm, and the serum carcinogenic antigen 19-9 level had increased from 635 U/mL to 1,918 U/mL. To prevent spontaneous rupture, laparotomy was performed, and the cyst was pathologically diagnosed as a splenic epithelial cyst.
Collapse
Affiliation(s)
- Toru Matsui
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|