Laparoscopic Splenectomy

Introduction

In veterinary patients, total splenectomy (via ventral midline laparotomy) is commonly performed for benign or malignant neoplasia, splenic torsion, and infiltrative diseases. In humans, laparoscopic splenectomy (LS) was first described in 1991 by Delaitre and Maignien and, through various modifications in technique, is now considered the standard of care for patients requiring total splenectomy. Numerous studies have shown that humans undergoing LS have a reduced length of hospital stay, decreased perioperative pain, and lower complications rates compared with open splenectomy.

Laparoscopic surgery has gained tremendous popularity in veterinary medicine and LS has been described in dogs and cats. In a study where multiport LS (MLS) was performed in healthy dogs without diseased spleens, reduced post-operative pain, wound complications and blood loss was found compared with open splenectomy. However, surgical time was significantly longer in the MLS group. Another study on MLS in 10 dogs with splenic pathology reported a 90% success rate (conversion in 1 dog was required due to omental adhesions and obstruction of splenic visualization from falciform fat). In the same study, median surgical time was 61.5 minutes (range 31-100 minutes) which is significantly longer than what is reported for open splenectomy in dogs.

Single incision platforms are being used with increasing frequency in veterinary medicine. Single incision laparoscopic splenectomy (SILS) has been described in an experimental study in dogs and has been performed in clinical cases by several minimally invasive surgeons. The challenge with SILS is the reduced triangulation resulting in instrument clashing and inability to maneuver the spleen to access the splenic hilus for vessel-sealing. [...]