The spleen is a solid organ located in the left upper abdomen. Its main functions are to remove old red blood cells, to act as a reservoir for certain blood products, and to play a moderate role in immune function. The intimate interaction of the substance of the spleen and blood components (platelets, red blood cells, white blood cells, bacteria and foreign substances) allows the spleen to remove and destroy abnormal or foreign materials from the body.
In certain disease states, the spleen may become enlarged, inflamed, or may cause destruction of normal blood elements. The most common example of this is idiopathic thrombocytopenic purpura (ITP), where the spleen destroys platelets, reducing the body's ability to clot blood.
Medications such as steroids can be used successfully in many cases to reverse the undesirable removal of excessive amounts of platelets, but in other cases may fail or lead to unacceptable side effects. When patients fail medical therapy, they are referred for surgical removal of the spleen.
Removal of the spleen (splenectomy) is usually very well tolerated once the patient recovers from the surgery. Vital function of the spleen may be duplicated by vaccination. Patients do require a vaccination to help prevent infection as a result of partial loss of immune function secondary to splenectomy. The chances of developing post-splenectomy sepsis is low, but still possible despite the reduced risk after vaccination.
Traditionally, splenectomy required a large midline or left upper abdominal incision. This results in substantial pain and discomfort and a prolonged recovery period. Inpatient hospitalization generally is about a week in length because of pain management and recovery of normal intestinal function.
Over the past 10 years, a relatively new surgical technique has emerged which utilizes a videoendoscopic approach to splenectomy. This technique involves the use of multiple 3/4 inch skin incisions through which ports are placed to allow access of surgical instruments and a high resolution camera. This allows surgery to proceed without the need for a large and debilitating incision.
In preparation for the videoendoscopic operation, the patient is placed on the operating table on their back or right side down. Carbon dioxide gas is then instilled under pressure into the abdominal cavity via a needle to create a working space for the dissection.
The ports are placed to allow passage of instruments for dissection. The surgeon then performs the operation by manipulating the instruments while viewing the inside of the abdomen via a video monitor.
As the operation proceeds, the surgeon frees up the attachments to the spleen and divides the main blood supply to the spleen with a series of clips and scissors. The spleen is then placed into a plastic bag in the abdomen to prevent spillage and then crushed into pieces. The fragments of spleen and the plastic bag are then removed through one of the small incisions.
The patient recovery period is markedly reduced and patients are typically discharged from the hospital in two to three days on minimal pain medication. The videoendoscopic approach infrequently needs to be converted to a standard open operation for safety purposes in the event of bleeding or difficult dissection secondary to excessive scar tissue from prior surgery.
The use of videoendoscopic technology has revolutionized the way surgical diseases are performed. In skilled hands, videoendoscopic splenectomy is successful in treating the underlying disease, safe, and is associated with markedly improved patient satisfaction.