Abdomlnol Extrointestinol Surgery o $p

88 o Surgtcol Procedures

lncluding Minlmol Access Procedures

Hypothermia mattress (available) I\4anometer (for measuring portal pressure) Cell saver (optional) lnstrumentotion Major procedures tray Long instruments traY Gastrointestinal procedures tray Biliary tract traY (available)

SPLENECTOMV

Definition
Removal of the spleen.
Discussion

Most common indication for splenectomy is accidental

injury. Other indications include hematologic disorders, tumors, cysts, or splenomegaly, and in staging of Hodgkin's disease. Splenectomy may also be indicated as the result of trauma during surgery, as in gastrectomy or mobilization of the splenic flexure of the colon; an attempt is made to preserve the traumatized spleen with
guture techniques and hemostatic agents. Splenectomy

Thoracotomy tray (for thoracoabdominal approach) Hemoclip appliers (various sizes and lengths) Supplies

Basin set
Blades (3) No. 10 Electrosurgical Pencil Suction tubing Hemoclips (various si?es) Dissectors (e.g., Peanut) Needle magnet or counter Hemostatic" agents (e. g., Helistat, Hemostat, Thrombostat, Avitene, crYoPreciPitate) Vessel loops (optional)

is avoidecl whenever possible to avoid the necessity for indefinite protection against pneumococcal pneumonia. Accessory spleens may be present in perisplenic tissues; rarely they are found in more removed sites. Procedure
A midline or left subcostal incision is made. The spleen is identified and the splenic hilum is isolated, taking care not to injure the tail ofthe pancreas. The splenic vessels (may be multiple) are divided and ligated. The enlarged spleen may be adherent to.surrounding structures incluiling the parietal peritoneum and diaphragm. The spleen is removed. The wound may be ir-

For Thoracoabdominal Approach' Add

Chest tubes (e.g., ArgYie)

Intrapleural

Y-connector "etl"d Bulb syringe

drainage unit (e.g', Pleurevac)

rigated. Hemostasis is achieved, and the wound is elosed in layers. If optimal hemostasis cannot be achieved or there is a question of pancreatic rnjury, a
dosed suction unit may be employed.

SpeciolNotes Inquire if a hypothermia mattress is necessary'

Confi"m wiil dered are ready and available. Special liver sutures are available. may be employed. Weigh sponges. benzoin,

Reporotion of the Potient

blood bank that the number of units or-

lbe patient is supine; arms may be extended. on armboards for an abdominal approach. Rarely, a thoracoabdominal approach is indicdted for massive splehomegaly. Skin Preporotion

Cavitron or plasma scalpel argon beam coagulator

Kee! accurate record ofthe amount ofirrigation used' Profect skin under adhesive' tape with tincture of

Begin at the incision extending from the axilla to just above the pubic symphysis, and down to the table at the
sides.