| Theme |
Pitfalls of Laparoscopic Surgery |
| Title |
Pitfalls of Laparoscopic Splenectomy |
| Author |
Hideo Shimura |
Department of Surgery 1, Kyushu University Faculty of Medicine |
| [ Summary ] |
Laparoscopic splenectomy is now substituted for conventional open splenectomy in cases with disorders such as of idiopathic thrombocytopenic purpura. A good operative field is obtained with the head elevated right lateral position and by handling of the spleen with a snake retractor. It is safe and feasible to divide the splenic hilar vessels with staplers used after dissection of surrounding ligaments. The harrmonic scalpel is more useful for hemostasis of the surrounding arteries than simple clipping. Clipping should be avoided if possible to prevent the disability associated with staplers on the hilum. The accessory spleen should be removed but is difficult to find on laparoscopic exploration. Preoperative examinations are helpful. Neither postoperative bleeding of splenic vessels, splenic fistula nor arteriovenous fistula has been encountered with the use of two staplers on the splenic hilum. |