Hand-assisted laparoscopic splenectomy for idiopathic thrombocytopenic purpura during pregnancy

A successful case of a hand-assisted laparoscopic splenectomy with low-pres sure pneumoperitoneum for autoimmune thrombocytopenic purpura in a patient at 23 weeks',gestation is reported. Preoperative splenic arterial embolizat ion was performed on the same day as the operation using painless contour e mbolic material and super-absorbent polymer microspheres. The abdominal wal l retraction method first was applied to avoid the effects of pneumoperiton eum on systemic hemodynamic alterations. However, a sufficient surgical vie w could not be obtained, as the intra abdominal organs were elevated becaus e of the enlarged uterus. A surgical view with 4 to 6-mm Hg pneumoperitoneu m was available for the hand-assisted splenectomy. The postoperative course was uneventful, and the patient vaginally delivered a healthy infant. A ha nd-assisted laparoscopic splenectomy with low-pressure pneumoperitoneum aft er splenic arterial embolization would be feasible for patients with autoim mune thrombocytopenic purpura during a relatively advanced pregnancy.