Laparoscopic Surgery of the Spleen

Foreword
Preface
Contents
About the Editor
Editors and Contributors
1: Overview and Prospects of Laparoscopic Splenectomy
1.1 Overview
1.2 Indications
1.2.1 Hematological Disorders
1.2.2 Splenomegaly and Hypersplenism Secondary to Liver Cirrhosis and Portal Hypertension
1.2.3 Occupying Lesions of the Spleen
1.2.4 Spleen Injury
1.2.5 Miscellaneous
1.3 Contraindications
1.3.1 Absolute Contraindications
1.3.2 Relative Contraindications
1.3.2.1 Supermassive Splenomegaly
1.3.2.2 Thrombocytopenia
1.3.2.3 Morbid Obesity
1.3.2.4 Elderly
1.3.2.5 Pregnancy
1.4 Comparison Between LS and OS
1.4.1 Literatures
1.4.2 Results
1.4.3 Conclusions
1.4.4 Discussion
1.5 Hand-Assisted Laparoscopic Splenectomy (HALS)
1.5.1 Literatures
1.5.2 Results
1.5.3 Conclusions
1.5.4 Discussion
1.6 Single-Incision Laparoscopic Splenectomy (SILS)
1.6.1 Literatures
1.6.2 Results
1.6.3 Conclusions
1.6.4 Discussion
1.7 Robotic Splenectomy (RS)
1.7.1 Literatures
1.7.2 Results
1.7.3 Conclusions
1.7.4 Discussion
1.8 Laparoscopic Partial Splenectomy (LPS)
1.8.1 Literatures
1.8.2 Results
1.8.3 Conclusions
1.8.4 Discussion
1.9 Laparoscopic Splenectomy in Children
1.9.1 Literatures
1.9.2 Results
1.9.3 Conclusions
1.9.4 Discussion
1.10 Portal Venous Thrombosis After Laparoscopic Splenectomy
1.11 Prospects
References
2: Anatomy and Physiology of the Spleen
2.1 Embryology and Clinical Anatomy of the Spleen
2.1.1 Embryology of the Spleen
2.1.2 Congenital Dysplasia of the Spleen
2.1.2.1 Accessory Spleen
2.1.2.2 Asplenia and Polysplenia
2.1.2.3 Wandering Spleen
2.1.2.4 Fusion of the Spleen Tissues with Organs
2.1.3 Clinical Anatomy of the Spleen
2.1.3.1 Shape, Position, and Adjacency of the Spleen
2.1.3.2 Ligaments of the Spleen
Gastrosplenic Ligament
Lienorenal Ligament
Splenophrenic Ligament
Splenocolic Ligament
Anterior Spleen Plica
Phrenicocolic Ligament
Pancreaticocolic Ligament
2.1.3.3 Lobes and Segments of the Spleen
2.1.3.4 Sectional Anatomy of the Spleen
2.1.3.5 Splenic Notch
2.2 Blood Supply, Lymphatic Circulation, and Innervation of the Spleen
2.2.1 Blood Vessels of the Spleen
2.2.1.1 Splenic Artery
Course of the Splenic Artery
Branches of the Splenic Artery
2.2.1.2 Splenic Vein
2.2.1.3 Double Circulation Pathway of the Spleen
2.2.1.4 Division of the Spleen
2.2.2 Lymphatic Circulation of the Spleen
2.2.3 Innervation of the Spleen
2.3 Physiology of the Spleen
2.4 Imaging Anatomy of the Spleen
2.4.1 Ultrasonography Anatomy of the Spleen
2.4.2 CT Anatomy of the Spleen
References
3: Pathology and Pathophysiology of Surgical Spleen Diseases
3.1 Blood System Diseases
3.1.1 Autoimmune Hemolytic Anemia
3.1.2 Immune Thrombocytopenic Purpura
3.1.3 Lymphoma
3.2 Portal Hypertension
3.3 Splenic Space-Occupying Lesion
3.3.1 Splenic Cyst
3.3.2 Hemangioma of Spleen
3.3.3 Splenic Metastasis
3.4 Traumatic Splenic Rupture
References
4: Perioperative Management of Laparoscopic Splenic Surgery and Application of Enhanced Recovery After Surgery (ERAS)
4.1 Background
4.2 Preoperative Preparations
4.2.1 Strict Identification of the Indications of LS
4.2.2 Preoperative Education
4.2.3 Preoperative Nutrition Screening and Nutritional Support Therapy
4.2.4 Preoperative Fasting and Water Deprivation
4.2.5 Preoperative Intestinal Preparation
4.2.6 Prophylactic Use of Antibiotics
4.2.7 Preoperative Nasogastric Tube Indwelling
4.2.8 Prophylactic Antithrombotic Therapy
4.3 Intraoperative Measures
4.3.1 Incision Selection
4.3.2 Prevention of Intraoperative Hypothermia
4.3.3 Placement of Intraoperative Abdominal Drainage Tube
4.4 Postoperative Measures
4.4.1 Early Postoperative Oral Feeding and Nutritional Support
4.4.2 Prevention and Treatment of Postoperative Nausea and Vomiting
4.4.3 Postoperative Analgesia Management
4.4.4 Early Postoperative Activities
4.4.5 Postoperative Removal of Abdominal Drainage Tube
4.4.6 Postoperative Catheter Removal Timing
4.4.7 Reduction of Postoperative SRMD
4.5 Discharge Criteria
4.6 Conclusions and Future Prospects
References
5: Laparoscopic Splenectomy (LS)
5.1 Background
5.2 Indications and Contraindications
5.2.1 Indications
5.2.2 Contradictions
5.2.2.1 Absolute Contradictions
5.2.2.2 Relative Contraindications
5.3 Preoperative Assessment and Preparation
5.4 Surgical Procedures
5.4.1 Surgical Position and Surgeon Position
5.4.2 Main Steps
5.4.2.1 Pneumoperitoneum Establishment
5.4.2.2 Abdominal Cavity Exploration
5.4.2.3 Dissociation of the Spleen
5.4.2.4 Exposure and Dissection of the Splenic Pedicle
5.4.2.5 Extraction of the Spleen
5.4.2.6 Placement of the Drainage Tube
5.4.2.7 Quit the Pneumoperitoneum and Suture the Incision
5.5 Key Surgical Techniques
5.5.1 Choice of Approach
5.5.2 Dissociation of Superior Splenic Pole
5.5.3 Do’s and Don’ts When Dissecting Peri-splenic Ligaments
5.5.4 Notices for Assistants
5.5.5 Trocar Placement and Precautions
5.5.6 Abdominal Exploration
5.6 Special Intraoperative Circumstances and Handling Skills
5.6.1 Handling Skills for Severe Abdominal Adhesions
5.6.2 Handling Skills for Splenic Pedicle
5.6.3 Autotransfusion
5.6.4 Conversion to Open Surgery
5.6.5 Handling Skills for Splenomegaly
5.7 Postoperative Management and Prevention and Treatment of Complications
5.7.1 Key Points of Postoperative Management
5.7.2 Prevention and Treatment of Postoperative Complications
5.7.2.1 Complications After Splenectomy
5.7.2.2 Common Complications Associated with Laparoscopy Technology
Complications Related to Puncture
Subcutaneous Emphysema
Hypercapnia or Acidosis
5.8 Hot Topics and Future Prospects
5.8.1 Safety and Effectiveness
5.8.2 Specimen Removal Specifications
5.8.3 Future Prospects
References
6: Single Incision Laparoscopic Splenectomy (SILS)
6.1 Background
6.2 Indications and Contraindications
6.2.1 Indications of SILS
6.2.2 Relative Contradictions of SILS
6.2.3 Absolute Contradictions of SILS
6.3 Preoperative Assessment and Preparation
6.3.1 Skin Preparation in the Field of Operation
6.3.2 Routine Biochemical Tests
6.3.3 Gastrointestinal Preparation
6.3.4 Medicine Preparation
6.4 Surgical Procedures
6.4.1 Surgical Position and Surgeon Position (Fig. 6.1)
6.4.2 Main Steps
6.5 Key Surgical Techniques
6.5.1 Techniques for Dissociation of the Spleen via Single-Incision
6.5.2 Treatment of Splenic Artery
6.5.3 Treatment of Splenic Hilum
6.5.4 Techniques for Specimen Removal
6.6 Special Intraoperative Circumstances and Handling Skills
6.6.1 Intraoperative Hemorrhage
6.6.2 Adjacent Organ Injury
6.7 Postoperative Management and Prevention and Treatment of Complications
6.7.1 Routine Postoperative Care
6.7.2 Common Postoperative Complications and Their Prevention and Treatment
6.8 Hot Topics and Future Prospects
6.8.1 Advantages of SILS
6.8.2 Disadvantages of SILS
6.8.3 Future Prospects
References
7: Hand-Assisted Laparoscopic Splenectomy
7.1 Background
7.2 Indications and Contraindications
7.2.1 Indications
7.2.2 Contraindications
7.3 Preoperative Assessment and Preparation
7.3.1 Physical Examination
7.3.2 Assessment and Preparation of the Patients
7.3.3 Imaging Examination
7.4 Surgical Procedures
7.4.1 Surgical Position and Surgeon Position
7.4.2 Main Steps
7.5 Key Surgical Techniques
7.6 Special Intraoperative Circumstances and Handling Skills
7.6.1 Bleeding
7.6.2 Peripheral Organ Injury
7.7 Postoperative Management and Prevention and Treatment of Complications
7.7.1 Postoperative Management
7.7.2 Prevention and Treatment of Postoperative Complications
7.8 Hot Topics and Future Prospects
7.8.1 Advantages of HALS
7.8.2 Disadvantages of HALS
7.8.3 Future Prospects
References
8: Laparoscopic Partial Splenectomy
8.1 Background
8.2 Indications and Contraindications
8.2.1 Indications
8.2.1.1 Splenic Neoplasia
8.2.1.2 Traumatic Rupture of the Spleen
8.2.2 Contraindications
8.3 Preoperative Assessment and Preparation
8.3.1 Basic Assessment of Patient
8.3.2 Radiography Assessment
8.3.3 Preoperative Preparation
8.4 Surgical Procedures
8.4.1 Surgical Position and Surgeon Position
8.4.2 Main Steps
8.4.2.1 Routine LPS
8.4.2.2 Selective Splenic Pedicle Occlusion
8.5 Key Surgical Techniques
8.5.1 Dissection of Spleen Vessels
8.5.2 Intraoperative Location of Splenic Space-Occupying Lesions
8.5.3 Hemostasis of Spleen Section
8.6 Special Intraoperative Circumstances and Handling Skills
8.6.1 Bleeding During the Dissection of Spleen Hilum
8.6.2 Adjacent Organ Injury
8.7 Postoperative Management and Prevention and Treatment of Complications
8.7.1 Postoperative Management
8.7.2 Prevention and Treatment of Postoperative Complications
8.8 Hot Topics and Future Prospects
8.8.1 Theoretical Basis of Laparoscopic Partial Splenectomy
8.8.2 Discussion on Indications of Laparoscopic Partial Splenectomy
8.8.3 Intraoperative Bleeding Control of Laparoscopic Partial Splenectomy
8.8.4 Time Limit of Splenic Artery Occlusion
8.8.5 Disconnection of Spleen and Dissociation of Ligament
8.8.6 Disadvantages of Laparoscopic Partial Splenectomy
8.8.7 Future Prospects
References
9: Laparoscopic Splenectomy Combined Selective Pericardial Devascularization
9.1 Background
9.2 Indications and Contraindications
9.2.1 Indications
9.2.2 Contraindications
9.3 Preoperative Assessment and Preparation
9.3.1 General Assessment
9.3.2 Imaging Assessment
9.4 Surgical Procedures
9.4.1 Surgical Position and Surgeon Position
9.4.2 Main Steps
9.4.2.1 Dissecting the Blood Vessels of Greater Gastric Curvature
9.4.2.2 Amputating the Posterior Gastric Vessels
9.4.2.3 Dissociating the Inferior Pole of the Spleen
9.4.2.4 Dissociating the Splenic Pedicle
9.4.2.5 Devascularizing the Perforator Veins of Gastric Lesser Curvature
9.4.2.6 Devascularizing the Perforator Veins of Esophagus
9.4.2.7 Taking the Specimen and Placing the Drainage Tube
9.5 Key Surgical Techniques
9.5.1 Pericardial Devascularization
9.5.2 Blood Autotransfusion
9.5.3 Hemostasis of Surgical Wound
9.6 Special Intraoperative Circumstances and Handling Skills
9.6.1 Bleeding
9.6.1.1 Handling Skills for Splenic Pedicle Injury
9.6.1.2 Handling Skills for Injury of Short Gastric Vessels
9.6.1.3 Handling Skills for Bleeding due to Spleen Injury and Devascularization
9.6.2 Adjacent Organ Injury
9.7 Postoperative Management and Prevention and Treatment of Complications
9.7.1 Postoperative Management
9.7.2 Prevention and Treatment of Complications
9.7.2.1 Postoperative Hemorrhage
9.7.2.2 Effusion of Splenic Fossa
9.7.2.3 Pulmonary Complications
9.7.2.4 Portal Vein Thrombosis
9.8 Hot Topics and Future Prospects
9.8.1 Theoretic Basis for Selective Pericardial Devascularization
9.8.2 Advantages of LSSPD
9.8.3 Disadvantages of LSSPD
9.8.4 Future Prospects
References
10: Laparoscopic Radical Antegrade Modular Pancreatosplenectomy
10.1 Background
10.2 Indications and Contraindications
10.2.1 Indications
10.2.2 Contraindications
10.3 Preoperative Assessment and Preparation
10.4 Surgical Procedures
10.4.1 Surgical Position and Trocar Placement
10.4.2 Exploration
10.4.3 Dissection of Upper and Lower Edges of the Pancreas
10.4.4 Treitz Ligament Approach
10.4.5 Disconnection of the Pancreas
10.4.6 Spleen Movement, Venous Disconnection, and Local Lymph Node Dissection
10.4.7 Resection and Cleaning of Retroperitoneal Tissue
10.4.8 Spleen Dissociation
10.4.9 Taking the Specimen and Placing the Drainage Tube
10.5 Key Surgical Techniques
10.5.1 Anatomical Position and Resection Plane
10.5.2 Protection of Renal Veins and Blood Vessels Around Renal Arteries
10.5.3 Treatment of Inferior Mesenteric Vein
10.6 Special Intraoperative Circumstances and Handling Skills
10.6.1 Bleeding
10.6.2 Intraoperative Management of Pancreatic Stump
10.6.3 Anatomical Position and Resection Plane
10.7 Postoperative Management and Prevention and Treatment of Complications
10.7.1 Postoperative Management
10.7.2 Prevention and Treatment of Postoperative Complications
10.7.2.1 Pancreatic Fistula
10.7.2.2 Hemorrhage
10.7.2.3 Abdominal Infections
10.7.2.4 Postoperative Platelet Increase
10.7.2.5 Endocrine and Exocrine Insufficiency of Pancreatic Body and Tail After Surgery
10.8 Hot Topics and Future Prospects
10.8.1 Sufficient Preoperative Assessment
10.8.2 Safety of Laparoscopic RAMPS
10.8.3 The Key to Improve R0 Resection Rate
10.8.4 Current Problems of RAMPS
10.8.5 Future Prospects
References
Correction to: Overview and Prospects of Laparoscopic Splenectomy
Correction to: B. Peng (ed.), Laparoscopic Surgery of the Spleen,
Index