Splenectomy
Laparoscopy Q&A
What does a laparoscopic splenectomy involve?
Laparoscopy is a means of vision. Rather than making a large incision and looking directly into the abdomen, we make small incisions of 5 to 10 mm (1/5 to 2/5 inches) and use a telescope to see inside the abdomen. The scope is attached to a camera that lets us operate while watching on a television screen. The actual operation is done the same way, but rather than using a 6 to 8 inch incision as for open surgery, we use five small incisions in laparoscopic surgery: two that are 5 mm (about 1/5 of inch) and three that are 10 mm (about 2/5 of inch). We then pass tubes through these incisions to allow access into the abdomen and we expand the abdomen with carbon dioxide gas to provide a space to work in. Our hands never enter the abdomen. Instead, we use long instruments that we pass through the small tubes. One might compare laparoscopic surgery to open surgery like eating with chop sticks as compared to a knife and fork!
How does my spleen come out those small incisions?
- Once the spleen is completely disconnected from its attachments and blood supply it is placed in a heavy polyethylene bag that is introduced through a site at the navel.
- We then make the incision at the navel a little larger, about 1 inch, and pull the bag to the surface.
- Next, we take the spleen out of the bag piecemeal until it completely out of the abdomen. This step is performed very carefully so that we don’t rip the bag. We are also very careful not to leave any small pieces of spleen in the abdomen, since they can implant and grow there.
How long does a laparoscopic splenectomy take to perform?
Usually the operation takes from 60 minutes to two hour. The biggest determinates of operative time are the size of the spleen and how much fatty tissue is present around it.
Do I go home the same day after laparoscopic splenectomy?
No. Patients must stay in the hospital overnight to monitor them for rare complications, such as bleeding and vomiting. Most patients, however, do go home on the following day.
What is the recuperation for laparoscopic splenectomy?
The major advantage of laparoscopic surgery over open conventional surgery is the significantly shorter recuperative period. This is because of the smaller incisions used. A few patients are able to perform normal activities the day they go home but most people require 2 to 3 days to return to normal. Although some patients return to work in 3 to 4 days, most return to work two to three weeks after surgery.
What factors make me less that optimal candidate for a laparoscopic approach?
There are a variety of factors which decrease the chance of the surgeon being able to complete the procedure laparoscopically. These include:
- Larger spleen than anticipated
- Inflammation
- Previous surgery
- Unclear anatomy
- Pregnancy
- Previously unrecognized abnormalities
- An intraoperative problem, such as bleeding
Conversion of a laparoscopic procedure to an open one should not to be viewed as a complication, since some patients simply are unable to be have the surgery performed laparoscopically without undue risk. Our goal is to perform a safe and uncomplicated procedure. Therefore, we will not take unnecessary risks just to complete the procedure laparoscopically.
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