Minimal access surgery for organ-sparing interventions with laser light in closed spleen injury: Advantages and disadvantages

Abstract

Actuality . Surgical interventions in case of spleen injury are aimed to achieve a reliable hemostasis, but due to the morphological structure of the spleen suturing does not lead to this goal; therefore, in most cases, surgeries end with splenectomy. However, removal of the spleen causes postplenectomic hyposplenism, and it urges to search for other modalities alternative to splenectomy. Purpose . To assess the effectiveness of interventions with minimal access in the left hypochondrium for organ-sparing surgery (OSS) on the spleen with laser light application. Material and methods . Outcomes of surgical treatment in 126 patients with closed spleen injury were analyzed. Of the total number of patients, organ-preserving surgeries with laser light were performed in 59 (46.8%) cases; among them 36 (28.6%) patients were operated on with minimal access surgery, and in case of upper midline laparotomy – in 23 (18.2%) cases. Medilas fibertom 5100 laser device (DORNIER Ltd) with wavelength 1064 nm was used for the discussed organ-sparing surgeries. In all cases, surgeries were ended with drainage of the abdominal cavity. Results . As it has been found out, the most optimal technique for OSS in spleen injury is laparoscopy which allows not only to evaluate the volume of intra-abdominal blood loss, but also to define the nature of spleen injury and presence or absence of damage to other abdominal organs. The minimal approach for closed spleen injury has both advantages and disadvantages. The advantages are technical convenience in performing surgery on the spleen and possibility to apply laser technology for OSS. However, OSS with laser light on the spleen with closed injury is recommended if patient’s hemodynamics is stable, organ injury is isolated, OSS is technically possible and there is no any damage to vessels of the spleen hilus. A significant disadvantage of minimal access surgeries is inability to perform a thorough revision of abdominal organs what is compulsory in urgent cases. Conclusion . Minimal access surgery with high-level laser energy in closed spleen injury is possible only if spleen injury is isolated.