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1.
Advances in imaging techniques have made preoperative diagnosis of splenic tumors possible. A case of successful laparoscopic
splenectomy for splenic hamartoma is described here and the indications of this technique are discussed.
Received: 12 January 1996/Accepted: 22 March 1996 相似文献
2.
Laparoscopic splenectomy (LS) has recently been gaining acceptance as an alternative to open splenectomy. However, several
aspects, such as learning curve, residual splenic function, and management of large spleens, remain controversial. In this
paper we present the analysis of technical details and immediate and late outcome of a consecutive series of 64 cases of splenic
disorders approached by laparoscopy. Between Feb-1993 and April-1997, 64 patients with a wide range of splenic disorders were
treated by laparoscopy, and prospectively recorded. Age, body mass index, operative time, number of trocars, perioperative
transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia,
stay and morbidity were analyzed. Late failures after LS were reevaluated with 99mTc-heat-damaged red blood cells scintigraphy and CT. LS was performed in 61 patients, and two cases with splenic cyst and
one splenic artery aneurysm received a laparoscopic partial cystectomy and aneurysmectomy. LS was performed through an anterior
approach in 12 patients and laterally in 49. Conversion rate was 6.5%. Accessory spleens were found in 7 patients (7/61, 11.5%).
Morbidity was 16%. There was no correlation between the weight of the spleen, platelet count or obesity with operative time.
A lateral approach was associated with a decrease in operative time (p < 0.002), postoperative stay (p < 0.001), transfusion
(p < 0.04) and number of trocars (p < 0.001). Operative time was significantly longer in large spleens (>1000 gr) (p < 0.001).
However, there were no differences in transfusion rate, stay, morbidity or conversion rate. After a follow up of 12 m, 10
patients revealed a low platelet count. Scintigraphy showed residual splenic tissue in 3 (ITP). A wide range of splenic disorders
can be treated by laparoscopy, including enlarged spleens. This technique should be continually audited, but initial results
reflect the approach's safety and advantages provided that great technical care is taken and an exhaustive search for accessory
spleens is conducted.
Received: 29 January 1997/Accepted: 22 May 1997 相似文献
3.
Vladimir Alexi-Meskishvili Stanislav Ovroutski Ingo Dhnert Thomas Fischer 《European journal of cardio-thoracic surgery》2000,18(6):795-726
A cor triatriatum sinistrum was successfully treated by operation in a 14-week-old infant of a Jehovah's Witness family. The child was pretreated with erythropoietin until a hemoglobin level of 14 g/dl was obtained. There was no cardiac catheterization before the operation. The operation was performed with cardiopulmonary bypass. No blood products were transfused and the hemoglobin level after performing modified ultrafiltration was 11.5 g/dl. The infant was extubated on the same day and discharged from our institution on the eighth day after surgery. Two years after surgery the child is in sinus rhythm and is developing well. 相似文献
4.
Background: The purpose of this study was to evaluate the outcome of patients undergoing laparoscopic splenectomy (LS) at the University
of California, San Francisco.
Methods: The medical records of the initial 52 unselected patients undergoing LS were reviewed and compared to 28 concurrently treated
open splenectomy patients (OS).
Results: Patients did not differ with regard to age, gender, body, or splenic weights. The operative time was longer in the LS patients
(mean 196 vs 156 min), but the length of stay and duration of ileus were shorter in the LS group. For adult patients admitted
exclusively for splenectomy, operative times did not differ between LS and OS and total hospital cost was less in the LS group
(mean $8,939 vs $14,022). Six patients required conversion to OS, four occurring in the first 11 patients treated (overall
conversion rate of 11%). Three patients died from complications related to their underlying disease. Two other major complications
occurred. Complication rates and transfusion requirements did not differ between OS and LS patients.
Conclusions: Laparoscopic splenectomy is a safe and effective alternative to open splenectomy for treatment of hematologic diseases in
patients of all ages.
Received: 16 April 1996/Accepted: 5 July 1996 相似文献
5.
Hand-assisted laparoscopic splenectomy 总被引:7,自引:1,他引:6
Laparoscopic splenectomy is performed routinely in patients with small and moderately enlarged spleens at specialized centers.
Large spleens are difficult to handle laparoscopically and hand-assisted laparoscopic splenectomy might facilitate the procedure
through enhanced vascular control, easier retraction and manipulation, manual guidance of endostaplers, and clip appliers.
A technique of hand-assisted laparoscopic splenectomy is described.
Received: 4 August 2000/Accepted: 4 August 2000/Online publication: 18 October 2000 相似文献
6.
Laparoscopic splenectomy using a wall-lifting procedure 总被引:1,自引:1,他引:0
T. Nishizaki I. Takahashi T. Onohara K. Wakasugi T. Matsusaka K. Kume 《Surgical endoscopy》1999,13(10):1055-1056
A laparoscopic splenectomy using a hanger wall-lifting procedure is herein described. The patient is placed in the right
lateral position. The left lower chest and left abdominal wall are then lifted by three wires in two directions, left laterally
and vertical to the abdominal wall. The view of the operative field thus obtained is excellent. The lifting wires and bars
do not hinder the movement of the forceps, since the angles of the instruments to approach the spleen are different from those
of the wires. A laparoscopic splenectomy using this wall-lifting procedure avoids the usual complications associated with
pneumoperitoneum while still being technically comparable to a procedure with pneumoperitoneum.
Received: 7 October 1998/Accepted: 22 February 1999 相似文献
7.
S. Gentilli M. Velardocchia A. Ferrero S. Martelli F. Donadio 《Surgical endoscopy》1998,12(11):1345-1347
Background: With the evolution of laparoscopic surgery comes the need for specific instruments that apply traction to parenchymal tissue,
like the spleen, without exposing the organ to the associated high risk of bleeding. To meet this need, we designed and developed
a suction-cup grasper that allows easy grasping and manipulation of the spleen. Some of the difficulties usually encountered
during laparoscopic splenectomy may be overcome by using this device.
Materials: The instrument consists of a cone-shaped, silicone rubber suction cup designed with an antislip internal surface. The cup
is connected to a support arm with a flexible distal end that can be rotated. Traction is exerted with a commonly available
suction system. The device is inserted through a 12-mm-diameter guide sheath.
Results: The two interventions performed with the atraumatic device were completed with laparoscopic technique. No complications arose
during or after the operations. The average operating time was 110 min. The patients were discharged after 4 and 5 days postoperative,
respectively.
Conclusions: As a device specifically designed for grasping parenchymal organs, the atraumatic suction grasper affords the operator a
faster and safer technique in laparoscopic splenectomy.
Received: 18 October 1996/Accepted: 16 May 1997 相似文献
8.
Laparoscopic splenectomy for ITP 总被引:6,自引:0,他引:6
R. L. Friedman M. J. Fallas B. J. Carroll J. R. Hiatt E. H. Phillips 《Surgical endoscopy》1996,10(10):991-995
Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic
purpura (ITP) was performed.
Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching
hospital between 3/91 and 8/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss, time to oral
fluid intake, direct costs, and operating room (OR) costs were analyzed.
Results: Age, sex, comorbidity, and spleen size were similar in both groups. LS was successful in 94% of patients in whom it was attempted.
Operative times showed a learning curve for LS, with average times for the last ten cases (94 ± 35 min) significantly shorter
than for the first ten (p= 0.01) and also shorter than for OS (103 ± 45 min). Postsurgical hospital stay was 2.9 ± 1.3 days for LS and 6.9 ± 3.0 days
for OS (p < 0.001). Patients tolerated an oral diet 1.2 ± 0.5 days after LS and 3.2 + 0.7 days after OS (p < 0.001). Direct hospital cost was $5,509 ± 3,636 for LS and $9,031 ± 12,752 for OS. In the LS group, six patients (21%)
had accessory spleens identified and removed, compared with two patients (11%) in the OS group. Platelet counts did not respond
in two (7%) patients in the LS group, but no accessory spleens were identified by nuclear scan. One major complication occurred
in the LS group. There were no cases of splenosis or mortality in either group.
Conclusions: LS is a safe and effective treatment for ITP, with significantly shorter postoperative hospital stay than OS.
Received: 26 March 1996/Accepted: 11 May 1996 相似文献
9.
Donini A Baccarani U Terrosu G Corno V Ermacora A Pasqualucci A Bresadola F 《Surgical endoscopy》1999,13(12):1220-1225
Background: Laparoscopic splenectomy (LS) is becoming the gold standard in the treatment of several splenic diseases. Shorter postoperative
stay and more rapid return to full activity are the primary advantages of LS.
Methods: Prospective data collection of 44 consecutive LS (group 1) and comparison with a historical control group of 56 consecutive
open splenectomies (OS) (group 2) were performed for hematologic diseases.
Results: The LS patients started earlier on an oral diet (p < 0.0001) and left the hospital sooner (p < 0.0002) than OS patients. Less blood transfusion (p < 0.004) and pain medication (p < 0.0001) was required by LS patients. They also had fewer postoperative complications (p < 0.03). Compared by diagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started
to eat earlier (p < 0.0001) and left the hospital sooner (p < 0.01). Multivariate analysis showed that time to oral diet and postoperative stay was related to operative technique and
age. Morbidity and pain medications were related, respectively, to transfusion requirements and type of surgical approach.
Conclusions: Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach.
The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.
Received: 16 July 1998/Accepted: 20 January 1999 相似文献
10.
V. Laopodis E. Kritikos L. Rizzoti P. Stefanidis P. Klonaris P. Tzardis 《Surgical endoscopy》1998,12(7):944-947
Background: Splenectomy is indicated in patients with thalassemia major when they develop hypersplenism with subsequent need for increased
transfusions. Extreme splenomegaly is considered a restrictive factor for laparoscopic splenectomy in these patients.
Methods: Laparoscopic splenectomy was undertaken in 12 β-thalassemia major patients with massive splenomegaly. The devascularization
of the organ was performed with serial ligations of the splenic vessels starting from the lower pole of the organ. The spleen
was extracted from the abdominal cavity through a 5-cm incision in the left iliac fossa, which incorporated two port sites.
Results: The procedure was concluded laparoscopically in 10 cases, while two patients were converted due to difficulty in controlling
bleeding from branches of the splenic vein. The patients tolerated the procedure well and had a postoperative hospital stay
of 3–6 days.
Conclusions: From our limited initial experience it seems that laparoscopic splenectomy in the difficult setting of thalassemia major
patients is feasible, but extreme care is required in order to avoid hemorrhagic complications.
Received: 21 March 1997/Accepted: 10 August 1997 相似文献
11.
A case is described in which a Jehovah's Witness patient who refused blood transfusion suffered massive antepartum haemorrhage, her haemoglobin falling as low as 2.0 g.dl(-1). She was treated on an intensive care unit with intermittent positive pressure ventilation and general supportive measures, pulsed hyperbaric oxygen therapy and recombinant human erythropoietin. 相似文献
12.
Nishida S Madariaga JR Santiago S Quintini C Palaios E Gyamfi A Rico R Hamamura K Haider H Moon JI Levi DM Casillas VJ Bejarano PA Tzakis AG 《Journal of Hepato-Biliary-Pancreatic Surgery》2007,14(3):312-317
Intrahepatic cholangiocarcinoma (ICC) is well known to have a very poor prognosis. Aggressive surgical strategies in the treatment
of ICC, including major hepatectomy, have been reported to afford patients the best chance for significant survival. Recent
advancements in surgical techniques concerning live donor liver transplantation have dramatically improved the results of
major hepatectomy. However, surgical treatment of biliary malignancy is complex and is known to increase the likelihood of
blood transfusion. We describe a Jehovah's Witness patient with ICC and concomitant bile duct invasion who had a successful
right trisectionectomy with bile duct resection, lymph node dissection, and Rouxen-Y hepatico-jejunostomy without blood transfusion.
A multidisciplinary preparation was crucial in obtaining this positive outcome. Importantly, bloodless liver transection techniques
with inflow clamping, meticulous dissection, and hemostasis should be utilized for major hepatectomy in a Jehovah's Witness.
The success of this case may alert clinicians to consider a hepatectomy as a possible option in the treatment of ICC in a
Jehovah's Witness. 相似文献
13.
C. J. Stanton 《Surgical endoscopy》1999,13(11):1083-1086
Background: Laparoscopic splenectomy (LS) has rapidly become the preferred surgical treatment for idiopathic thrombocytopenic purpura
(ITP), but its long-term efficacy for this disorder is unproved. This report documents the author's 5-year experience with,
and long-term follow-up of, LS for ITP.
Methods: Between September 1992 and September 1997, 30 patients with clinical ITP and intractable thrombocytopenia were referred as
surgical candidates. Two of them (7%) were converted to open, and the other 28 underwent successful LS. The operative approach
evolved from a supine lithotomy to right lateral decubitus position, and the harmonic scalpel became the primary dissection
tool in the later part of the study.
Results: The 28 successful LS patients constituted the study group. Accessory spleens were identified and resected in six patients
(21%). Surgical times and blood loss averaged 2.4 h and 170 cc, respectively. The typical hospital stay was 2 days. Initial
reversal of thrombocytopenia and ultimate cessation of oral steroids was achieved in 25 of 28 patients (89%). There were no
deaths, but two patients had major complications (bleeding and pneumonia). All but two patients experienced a return to full
activity and/or employment by 3 weeks post-LS. In the three cases that failed LS, none had residual splenic tissue on subsequent
radionuclide scan. Long-term follow-up (2–60 months) was obtained in 22 of 28 patients (79%). The only death (at 13 months)
resulted from oncologic disease. Twenty-one patients had lasting clinical remission of ITP. A positive preoperative response
to oral steroids was the best predictor of success.
Conclusions: This 5-year experience with LS supports its use for the surgical treatment of ITP. The procedure is safe and efficacious,
resulting in brief hospitalization, minimal recovery time, and excellent long-term results.
Received: 11 October 1998/Accepted: 19 February 1999 相似文献
14.
Background: A disparity exists between the incidence of accessory spleens reported in the open (15–30%) versus the laparoscopic (0–12%)
literature. This disparity implies that a percentage of laparoscopic patients will require a reoperation for accessory splenectomy.
We present our experience with the laparoscopic management of accessory spleens discovered after primary splenectomy for idiopathic
thrombocytopenic purpura (ITP).
Methods: Seventeen patients who underwent primary splenectomy for ITP were reviewed (1 open, 16 laparoscopic). In the laparoscopic
group, the incidence of accessory spleens was 3 in 16 (19%). In 1 of these 3 patients, the accessory spleen was found and
removed at the initial operation, whereas in 2 of the 16 patients (13%), the accessory spleens were missed. A third patient,
whose initial operation was open, presented with recurrent thrombocytopenia after primary splenectomy. After recurrent thrombocytopenia
developed, radio nuclide spleen scans were performed showing accessory spleens in all three patients. These three patients
underwent accessory splenectomy using a four-port laparoscopic approach.
Results: Laparoscopic accessory splenectomy was successfully performed in all three patients. Location of accessory spleens correlated
with the spleen scan in each case. Mean operation time was 180 min. There were no conversions to open surgery and no complications.
All patients were discharged from the hospital on postoperation day 1. The three patients had a good clinical response and
were weaned effectively from their steroid medications.
Conclusions: Patients undergoing a laparoscopic splenectomy for chronic ITP have a higher probability of requiring a reoperation for a
missed accessory spleen. To minimize missing an accessory spleen, a systematic search should be made at the beginning of the
laparoscopic operation. We have found that preoperation imaging with heat-treated erythrocyte scans is valuable for locating
accessory spleens before reoperation. When reoperation for accessory splenectomy is necessary, a laparoscopic approach is
safe and effective.
Received: 22 July 1998/Accepted: 13 October 1998 相似文献
15.
Laparoscopic enucleation of a solitary pancreatic insulinoma 总被引:7,自引:1,他引:6
Insulinomas are usually small, benign tumors of the pancreas, often found in obese patients, which require an incision that
is out of all proportion to the size of the lesion. A laparoscopic technique for enucleation of a pancreatic insulinoma is
described.
Received: 4 October 1994/Accepted: 18 September 1995 相似文献
16.
Background: The laparoscopic approach must be shown to be cost-effective as well as safe and technically effective before being widely
adopted. A review of 54 consecutive patients who underwent open and laparoscopic colposuspension is presented and a cost-analysis
is performed comparing the two approaches.
Methods: This study was a retrospective controlled review of patient records and accounts of in-hospital costs incurred at a private
hospital.
Results: Theater costs were significantly greater in the laparoscopic group but this was balanced by a shorter length of stay and
subsequent reduced accommodation cost. There was no difference in the overall in-hospital costs between the two groups.
Conclusion: The laparoscopic surgical approach is safe and effective and by no means more expensive than the open approach. In the future,
the laparoscopic approach can only become more cost efficient; techniques will improve and there will be earlier returns to
work and, subsequently, greater productivity.
Received: 19 August 1996/Accepted: 20 December 1996 相似文献
17.
Laparoscopic removal of a swallowed toothbrush 总被引:1,自引:1,他引:0
Toothbrush swallowing is an uncommon occurrence. Unlike most cases of foreign-body ingestion, there have been no cases of
spontaneous passage reported. Consequently, prompt removal is recommended before complications develop. We report a case of
toothbrush ingestion which failed attempted endoscopic removal. This patient was managed successfully with laparoscopic assisted
removal via gastrotomy. We recommend this approach for the removal of any ingested foreign bodies when surgical intervention
is indicated.
Received: 20 December 1995/Accepted: 1 March 1996 相似文献
18.
Splenic cysts are rare in pediatric surgery. Nowadays management consists of partial splenectomy or decapsulation of the
cystic wall. The case reported in this article describes the successful laparoscopic decapsulation of the cystic wall in an
11-year-old child.
Received: 25 September 1998/Accepted: 5 January 1999 相似文献
19.
Reardon PR Scarborough T Matthews B Preciado A Marti JL Brunicardi FC 《Surgical endoscopy》2000,14(3):298-299
Passing the stomach behind the esophagus during laparoscopic Nissen fundoplication is a common source of frustration for
the laparoscopic surgeon. It often leads to an incorrect formation of the fundoplication, resulting in a wrapping or twisting
of the fundus around the distal esophagus. The correct technique should result in the distal esophagus being enveloped inside
the fundus without distorting the orientation of the greater curve. We have developed an easy, precise, and reproducible technique
to perform this maneuver. The steps for performance of this maneuver are described.
Received: 12 March 1999/Accepted: 24 September 1999 相似文献
20.
Osamu Namura Hiroshi Kanazawa Katsuo Yoshiya Satoshi Nakazawa Yoshihiko Yamazaki 《Surgery today》2001,31(10):912-914
We report herein the case of a 47-year-old woman of the Jehovah's Witness faith in whom Y-grafting for a ruptured abdominal
aortic aneurysm was successfully performed without a homologous blood transfusion. We used a Cell Saver (Haemonetics, Braintree,
MA, USA) red cell salvaging device and an aortic occlusion balloon catheter, and performed gentle and minimal dissection during
the operation. Postoperatively, the patient was kept heavily sedated and required hypothermic therapy for only 14 h. We treated
her severe anemia using conventional drugs, including iron and folic acid, and her hemoglobin increased smoothly. Although
her hemoglobin level decreased to 2.8 g/dl during the operation, her postoperative course was uneventful.
Received: November 24, 2000 / Accepted: May 15, 2001 相似文献