Minimally invasive splenectomy: an update and review

Minimally invasive splenectomy: an update and review

Can J Surg 2013;56(4)280-285 | PDF

Gary Gamme, MD* Daniel W. Birch, MD, MSc† Shahzeer Karmali, BSc, MD†

From the * Faculty of Medicine, University of Calgary, Calgary, and the †Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta.

Abstract

Laparoscopic splenectomy (LS) has become an established standard of care in the management of surgical diseases of the spleen. The present article is an update and review of current procedures and controversies regarding minimally invasive splenectomy. We review the indications and contraindications for LS as well as preoperative considerations. An individual assessment of the procedures and outcomes of multiport laparoscopic splenectomy, hand-assisted laparoscopic splenectomy, robotic splenectomy, natural orifice transluminal endoscopic splenectomy and single-port splenectomy is included. Furthermore, this review examines postoperative considerations after LS, including the postoperative course of uncomplicated patients, postoperative portal vein thrombosis, infections and malignancy.

Résumé

La splénectomie laparoscopique (SL) est devenue la norme de soins établie pour la prise en charge des maladies de la rate justiciables d’une chirurgie. Le présent article fournit une mise à jour et une synthèse des interventions et des controverses actuelles entourant la splénectomie minimalement effractive. Nous passons en revue les indications et contre-indications de la SL, de même que les considérations préopératoires. Nous incluons une analyse individuelle des interventions et des résultats de la SL multiport, de la SL manuellement assistée, de la splénectomie robotisée, de la splénectomie endoscopique transluminale par voie naturelle et de la splénectomie par simple incision. De plus, cette synthèse explore les considérations postopératoires suivant la SL, y compris l’évolution postopératoire des cas non compliqués, la thrombose de la veine porte postopératoire, les infections et les cancers.


Accepted for publication Oct. 9, 2012

Competing interests: None declared for G. Gamme. D.W. Birch declares having been paid consultant fees by Johson & Johnson/Ethicon Endo-Surgery, Covidien, Bard, Baxter and Olympus. S. Karmali declares having received consultant and speaker fees from Ethicon and Covidien.

Contributors: All authors designed the review, analyzed the data, reviewed the article and approved its publication. G. Gamme and S. Karmali acquired the data. G. Gamme wrote the article.

DOI: 10.1503/cjs.014312

Correspondence to: S. Karmali 10240 Kingsway Ave., Rm. 405 CSC Edmonton AB T5H 3V9 shahzeer@ualberta.ca