LAPAROSCOPIC ASSISTED SPLENECTOMY FOR TREATMENT OF PRESUMED IMMUNE THROMBOCYTOPENIC PURPURA - INITIAL RESULTS

Objective: To present the initial results of performance of laparoscop ic splenectomy in two patients at Mayo Clinic Scottsdale. Design: We d escribe two 18-year-old patients with idiopathic immune thrombocytopen ic purpura and the technique of laparoscopic splenectomy used for trea tment. Material and Methods: For adequate visualization of the spleen and exposure of the upper midline area should urgent laparotomy become necessary, we position the patient supine with a sandbag under the le ft lower costal margin. Insertion of five 10-mm trocars facilitates pl acement of instruments. Dissection of the spleen is begun inferiorly. The splenic flexure of the colon is reflected inferiorly, and the sple en is rotated anterolaterally to allow division of the gastrosplenic l igament and the splenic hilum. Individual vessels are divided between clips, as are the short gastric vessels. Cautery is used for dividing the splenophrenic ligament. The spleen is placed in a plastic bag, and the open end of the bag is delivered through the umbilical incision, after which the spleen is morcellated and then removed. Considerable c are must be exercised to ensure that the plastic bag is not punctured and that no ectopic splenic tissue is present. Results: Both laparosco pic splenectomies were successful, and no intraoperative or postoperat ive complications occurred. After dismissal on postoperative day 3, th e patients quickly resumed all activities. The platelet counts returne d to normal. Conclusion: These encouraging results support the use of laparoscopic splenectomy for immune thrombocytopenic purpura and sugge st that this procedure may have a role in patients with other conditio ns of the spleen.