Splenectomy:
Open splenectomy: The incision and technique depends upon the need for surgery.
Emergency: A midline incision is preferred and rapid mobilisation of the spleen required to isolate the artery and vein to the spleen.
With control of these blood vessels the haemorrhage is controlled.
Elective: An incision below and in line wih the lower ribs on the left is commonly used.
The blood vessels supplying the spleen are isolated and divided to minimise blood loss.
The spleen is then removed from the abdomen and the wound closed.
Laparoscopic splenectomy: The patient is carefully positioned on the operating table.
Ports are placed as indicated.
The splenic blood vessels are secured and divided using laparoscopic instruments including a laparoscopic stapling device for the larger blood vessels.
Once the vessels are divided the spleen is separated from its attachments to the abdominal wall and placed in a secure retieval pouch.
The spleen is then broken up within the pouch to facilitate its removal via one of the larger incisions.
The wounds are closed and a small drain may be left in the region the spleen occupied.
If technically possible, and the spleen is not too large, a laparoscopic splenectomy is the preferred technique for elective splenectomy.