Laparoscopic Splenectomy

Laparoscopic splenectomy surgery

Laparoscopic splenectomy is a procedure aimed at removing a spleen through miniature keyhole incisions. It is currently the treatment of choice in most of the spleen-related conditions since it is associated with a faster recovery, less pain, and small scars in comparison with open surgery.

Indications (When It Is Needed)

A laparoscopic splenectomy can be advised in case of:

• The most common indication is idiopathic thrombocytopenic purpura (ITP).
• Hereditary spherocytosis
• Thalassemia (selected cases)
• Hypersplenism (spleen attacking blood cells)
• Splenic cysts or tumors
• Splenic abscess
• Splenic artery aneurysm
• Traumatic splenic (stable patients) injury.

Laparoscopic splenectomy procedure

Laparoscopic splenectomy is a type of minimally invasive surgery in which the spleen is excised by using a laparoscope (a camera) and a few small keyhole incisions to remove the spleen by means of laparoscopic tools. It is the method of choice with majority of these elective splenectomy cases.

Pre-Surgery Preparation

Immunizations (highly essential)

• Since the spleen removal predisposes to infection, it is the time of 2 weeks before surgery that vaccines are carried out:
• Pneumococcal vaccine
• Meningococcal vaccine
• Haemophilis influenzae type B (Hib) vaccine.
• Influenza vaccine (seasonal)

Blood tests

• CBC
• Coagulation profile
• Blood group and crossmatch

Imaging

• Abdominal ultrasound or CT scan.

General preparation

• Fasting 6–8 hours
• Discontinue prescribed blood thinners.
• Patient is put under a general anesthesia.

Laparoscopic Splenectomy Step by Step Procedure

Anaesthesia and Positioning

• Under general anaesthesia, patient is put under.
• Lying in right lateral decubitus (bent over to his left) with slight table roll.
• This is a location that allows the spleen to fall away to allow the safe dissection of the organs.

Production of Pneumoperitoneum

• A minor cut is created around the umbilicus.
• The abdomen is inflated with CO2 gas, which forms working space.
• The laparoscope is inserted using trocar (port).

Placement of Ports

As a rule, 3-4 supplementary ports are put in:

• One for the camera
• Two for working instruments
• A single retractable port is optional.
• Positions on the port are based on preference of the surgeon and size of the spleen.

Splenic Visualization and Exposure

• Surgeon examines the abdominal organs.
• Spleen is manipulated carefully and lifted upwards against the surrounding tissues.
• Splenic ligaments can be exposed with the help of instruments which help to retract the stomach, colon, or omentum.

Division of splenic ligaments 

A number of ligaments connect the spleen:

• Splenocolic ligament
• Splenorenal ligament
• Gastrosplenic ligament

The following are used to cut them carefully:

• Harmonic scalpel
• LigaSure
• Bipolar cautery
• This releases attachments of the spleen.

Management of Short Gastric Vessels

• The arteries and veins which connect between the stomach and spleen are closed and separated.
• Caution is exercised to prevent damage to pancreas and stomach tail.

The Splenic Hilum is dissected

• The hilum splenic artery and vein are identified.

They are cut or fastened with:

• Hemoclips
• Minimally invasive vascular stapler.
• The spleen is blocked in terms of blood supply.

Spleen Mobilization and Removal

• The spleen is then liberated completely and put in specimen retrieval bag.
• The bag is dragged out the biggest port.
• Morcellation (cutting it in sections within the bag) can be performed in the event of a big spleen to extract it without danger.

Hemostasis Check

• Whole splenic bed is checked with regard to bleeding.
• All bleeding points are cauterized or clipped.
• To have a clear view, irrigation might be applied.

Closure

• Gas is released.
• Ports are removed.
• Absorbable staples or sutures are used to close small incisions.
• Sterile dressing applied.

Duration of Surgery

• Depending on the size of the spleen, adhesions, and underlying disease 1.5-3 hours.

Key Instruments Used

• Laparoscope (camera)
• Trocars/ports
• Harmonic scalpel / LigaSure
• Endoscopic stapler
• Specimen retrieval bag
• Graspers and dissectors

Post-Surgery

• Patient transferred to the recovery room.
• Premature walking in 24 hours.
• Liquid diet either the same or the following day.
• Discharge usually in 2–3 days.

Benefits of laparoscopic splenectomy

The laparoscopic splenectomy has very important benefits over the traditional open splenectomy because of its minimal nature. It has become the procedure of choice in the majority of elective cases of spleen removal surgery.

Minimized Incisions (Cosmetic Advantage)

• It is carried out with the use of 3-4 small keyhole incisions instead of a big incision over the abdomen.
• Less scarring, improved cosmetic appearance, and tissue trauma.

Less Postoperative Pain

• The use of small incisions results into a very minimal amount of post-surgical pain.
• Patients have access to reduced pain drugs, which enhance comfort and safety.

Faster Recovery Time

• Normalcy in the patients is usually resumed after 2-3 weeks.
• The length of stay in the hospital is minimal (2-3 days versus 5-7 days in an open surgery).

Lower Risk of Complications

Minimally invasive methods decrease the risks of:

• Wound infection
• Hernia at incision site
• Respiratory complications

Excessive bleeding

• Laparoscopy also can be dissected better due to better visualization.

Reduced Blood Loss

• Further vessel-sealing instruments (Harmonic, LigaSure) aid in reducing bleeding.
• Enhanced magnification will be used to exercise caution in controlling short gastric vessels and hilum.

Enhanced Visualization

• Laparoscopy camera is high definition with magnified view of 10 times.

Delicate structures that can be seen by surgeons include:

• Short gastric vessels
• Tail of pancreas
• Splenic hilum
• Surrounding ligaments
• This leads to safer and precise surgery.

Faster Recovery of Bowel Function

• The resultant effect is reduced manipulation of abdominal organs.
• Post-operative ileus (provisional gut paralysis)
• Abdominal distension
• Patients are able to initiate liquids at an early stage and advance to normal diet at a quicker pace.

More Adaptable to Select Hematologic Conditions

In conditions such as ITP, hereditary spherocytosis and mild splenomegaly, laparoscopic splenectomy:

• Offers quality disease control.
• Has low complication rates
• Just effective rapid postoperative healing.

Reduce the total hospital expenses

The equipment will be more expensive, but overall costs might be smaller due to:

• Shorter hospital stay
• Less postsurgical complications.
• Faster discharge and work release.

Early Mobilization

The patients can walk and move much sooner owing to:

• Less pain
• Smaller wounds
• This lowers the chances of deep vein thrombosis (DVT) and enhances the general recovery.

High Patient Satisfaction

Because of:

• Minimal scarring
• Quick recovery
• Less pain
• Improved life after the surgery.

Factors Affecting Cost of laparoscopic splenectomy in India

The following is a brief, realistic analysis of the factors behind the prices of a laparoscopic splenectomy in India:

Hospital type / city / accreditation

• Since metro private tertiary hospitals in Delhi, Mumbai, Bengaluru, Chennai generally cost more than the smaller city or government hospitals. Apollo, Medanta, Fortis, and other accredited and high-volume centres are more expensive. 

Type of procedure laparoscopic or open / complexity

• The cost of laparoscopic splenectomy is higher than an open operation due to the use of specialized tools and more time in the OR duration; a complicated scenario (massive splenomegaly, adhesions) will raise the cost even more. 

Surgeon’s fees & team

• Senior consultants / specialists are more expensive to engage in professional fees. Bills can be done separately (consultant + assistant + anaesthetist). 

Operating room time and anaesthesia

• Extended surgeries or the necessity to have complex anaesthesia is more expensive. Complex cases can be of senior anaesthetist or ICU level. 

Consumables / devices (large cost driver laparoscopy)

• Endo-staplers, clips, specimen retrieval bags, sophisticated vessel-sealing equipment (LigaSure/Harmonic) and single-use trocars may tack some tens of thousands of rupees to the bill. 

Blood & blood products

• Transfusion (crossmatch, packed cells, plasma) is an unnecessary expense when it is needed - typical of hematologic or traumatic cases. 

ICU hospitalization / complications / open conversion

• In the event that post-op ICU is required, or where the surgeon may change to an open procedure due to bleeding/adhesions, the costs will increase significantly. 

Hospital length of stay and room type

• The prices of private AC deluxe rooms are higher than shared/basic wards; the charge is higher per additional inpatient day (room + nursing + meds). 

Pre-op/ post-op tests/ imaging

• Billed separately include CT abdomen, recurring laboratory tests, blood group crossmatch, specialist consults, and pathology (in case a specimen is sent). 

Vaccinations & prevention drugs

• Vaccinations against pneumococcal, meningococcal, Hib (pre-splenectomy) and any necessary prophylactic antibiotics are optional, particularly when they are done at privately run clinics. 

Patient issues / comorbidities

• Advanced age, diabetes, heart disease or other diseases enhance the risk of perioperative and monitoring needs, which will raise the cost. 

Medical tourism / facilitation fees (when necessary)

• Additional fees such as airport collection, translator, travel support and concierge services make the package more expensive.

Laparoscopic splenectomy recovery time

The laparoscopic splenectomy has a tendency to recover very fast due to the minimally invasive nature of the procedure. Patients recover much faster than in open surgery.

Emergency Postoperative Recovery (First 24 to 48 hours)

• Monitoring of patient is followed in recovery room and then transferred to a ward.
• The pain is normally mild to moderate and can be managed using oral painkillers.
• Walking is advised to patients within 12-24 hours.
• Liquids→ soft diet normally begins on the same day or the following day.
• Stay in hospital: 2-3 days on average.

First Week After Surgery

• In the majority of patients, the symptoms improve dramatically in 5-7 days.
• The stitches are normally dissolvable; otherwise, they are removed on average day 7-10.
• Light domestic labor is permitted.
• Do not overlift heavy objects, run too much or bend.

Complete Recovery Time

• Complete recovery: 2-3 weeks in the majority of the patients.
• Typical resumption of school/office work by patients is 10-14 days.
• Excessive activities, exercise in the gym or lifting heavy objects should be avoided within a period of 4-6 weeks.

Internal Healing

Although the external injuries would heal within a short time, internal healing is a slow process:

• The healing of splenic beds requires a period of 4 -6 weeks.
• Being able to reduce any bleeding or pressure symptoms reduce during the first 2-3 weeks.

When to Resume Driving

• Typically, after 1 week, in case the pain is not severe and there are no sedative drugs used.

Diet After Surgery

• Normal diet may be reintroduced in a number of days.
• In case the spleen is large and removed, the patient is still improves with time in terms of appetite.

Long-term Protection of Vaccination 

Since the spleen is removed:

• Vaccination (pneumococcal, meningococcal, Hib) should be current.
• Fever should be reported as soon as possible by the patient.
• Others might be put on long-term or on-demand antibiotics (as recommended by surgeon or hematologist).

Follow-Up Schedule

Typical follow-up timeline:

• 1 week – wound check (if needed)
• 2-3 weeks - Full recovery assessment by the surgeon.
• 6 weeks - reassessment of the opportunity to resume full activity.

Conclusion

Laparoscopic splenectomy is safe, effective and minimally invasive surgery that has emerged as the operation of choice in the removal of the spleen in most of the elective cases. It has great advantages compared to open surgery such as smaller incisions, less pain, quicker recovery and shorter time of stay in hospital. Through good preoperative vaccination, proper surgical procedure, and paying attention to the postoperative care, the patients tend to recover fast and resume normal activities in a few weeks. Even though the spleen is removed, which predisposes to long-term infections, they can be controlled by means of vaccines, timely treatment of fevers, and follow-ups. In general, laparoscopic splenectomy has high patient satisfaction and good clinical outcomes.

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FAQ

1. Does laparoscopic splenectomy cause pain?

• Pain is generally mild to moderate, far less than open surgery and it is easily controlled using oral analgesics.

2. Am I more likely to contract infections after removal of the spleen?

• Yes, due to the reason that the spleen is used to combat some bacterial infections. Proper vaccination and early intervention on fever are able to ensure that the risk is very minimal.

3. Are there any long term limitations to splenectomy?

• The patients are not to be exposed to serious infections, keep track of the vaccines and report any fever as soon as possible. Normal day to day life.

4. Is laparoscopic splenectomy safe for children?

• Yes, it is normally and safely done in children with disorders such as hereditary spherocytosis and the recovery is quick and scarring minimal.

5. Should I take antibiotics following splenectomy?

• There are patients where antibiotic prophylaxis may be necessary at the discretion of the doctor, most patients are children and those with some blood disorders.

6. Is it possible to travel after splenectomy?

• Yes, when you have come to your senses (normally after 2-3 weeks) and your doctor has given it. Store a vaccination record and have emergency antibiotics, where necessary.