Laparoscopic subtotal splenectomy

Since 1979, we have studied subtotal splenectomy. This procedure has been used in over 180 patients to treat splenic trauma, portal hypertension, myeloid metaplasia due to myelofibrosis, Gaucher's disease, chronic lymphocytic leukemia, retarded growth and sexual development associated with splenomegaly, and disorders of the pancreatic tail. The aim of this study is to determine the feasibility, reliability and safety of the subtotal splenectomy performed by laparoscopic means.

An experimental study was conducted in accordance with the International Guiding Principles for Biomedical Research Involving Animals. Fourteen adult mongrel dogs of both sexes were divided into 2 groups (n=7): Group 1 -- laparoscopic subtotal splenectomy, preserving the upper pole supplied by splenogastric vessels; the splenic section, hemostasis and closure was done with a 45 mm linear laparoscopic surgical stapler; Group 2 -- total splenectomy was performed through a median laparotomy. After 3 months, we accomplished hematological, immunological and scintigraphic exams in all animals. Sections of the remnant spleens, livers and lymph nodes were histologically processed.

Blood loss was minimal and all animals survived to operation and during the 3 months follow-up. Reduction (p<0.05) of the platelets was verified in Group 1. The rest of the hematological mean values remained normal. The remnant spleens, livers and lymph nodes showed normal histological aspects, with increasing amounts of polymorphonuclear cells observed in both groups.

It is feasible and safe to perform subtotal splenectomy by laparoscopic means in dog.