mesh1957 Jul 2, 2012
Surgery Specialty: General Surgery
This is a case of Laparoscopic splenectomy of a huge spleen in a young patient with sickle cell disease (SCD).
The indication for the procedure was recurrent acute splenic sequestration crises (ASSC).
After adequate...
This is a case of Laparoscopic splenectomy of a huge spleen in a young patient with sickle cell disease (SCD).
The indication for the procedure was recurrent acute splenic sequestration crises (ASSC).
After adequate preoperative preparation especially designed for SCD patients undergoing any surgical procedures, the patient was placed in supine position (different from the commonly adopted right lateral decubitus position) with both legs separated. The surgeon stands between the patient's legs.
Trocar placements:
One 10 mm in the mid-line above the umbilicus (for the camera),
One 13 mm in the MCL 4-fingers or a hand-breadth underneath the rib cage depending on the spleen size (for dissection, use of electrosurgical devices, stapling the splenic vessels and spleen extraction),
One 10 mm in the midline high in the epigastrium (for grasping and retraction, and
One 5 mm in the anterior axillary line (for retraction by the assistant).
Practical Notes:
1. Clipping the splenic artery early in the procedure in such cases helps to decrease the splenic size and congestion.
2. Use of Ligasure atlas is not suitable in taking the short gastric vessels due to close proximity of the stomach to the upper pole of the spleen./nAbdul-Wahed Meshikhes
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