LAPAROSCOPIC SPLENECTOMY - CLINICAL-EXPERIENCE AND THE ROLE OF PREOPERATIVE SPLENIC ARTERY EMBOLIZATION

We describe the clinical course of 12 patients who underwent laparosco pic splenectomy. Two patient, were converted to open surgery-the first patient in the series because of a hemorrhagic incident and the eight h, who had a 34-cm spleen, because of dissection difficulties. The rem aining patients had no mortality, and perioperative morbidity was 10%. After an average postoperative stay of 3.5 days (range, 2-9), most pa tients were able to resume normal activities less-than-or-equal-to 2 w eeks. Use of preoperative splenic artery embolization was begun with t he third patient. The technique involved embolization of the spleen wi th coils placed proximally; and contour emboli, absorbable gelatin spo nge, and small coils placed distally, taking care to spare vessels to the tail of the pancreas. A good linear correlation was established be tween operative blood loss and the percentage of splenic devasculariza tion by preoperative splenic artery embolization (r - 0.8084). Laparos copic splenectomy is becoming the preferred technique for elective rem oval of a normal sized or moderately enlarged spleen (<20 cm long) whe n hematologic indications are present.