Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation

Area of Science:

• Surgical Oncology
• Medical Imaging
• Gastroenterology

Background:

• Laparoscopic splenectomy (LS) is standard for normal spleens but challenging for splenomegaly due to hemorrhage risk.
• Understanding splenic vessel anatomy is crucial for difficult laparoscopic procedures.
• Color Doppler flow imaging (CDFI) can aid in visualizing splenic vasculature.

Purpose of the Study:

• To examine the role of CDFI in delineating splenic vessel anatomy.
• To evaluate the value of preoperative CDFI for facilitating laparoscopic splenectomy (LS).

Main Methods:

• Retrospective study of 48 patients undergoing splenectomy.
• Preoperative CDFI assessed splenic pedicle anatomy, vessel-pancreas relationship, and spleen size in 23 patients (CDFI group).
• LS in the CDFI group used imaging guidance; the non-CDFI group (25 patients) used conventional methods.

Main Results:

• All LS procedures were successful; 2 non-CDFI cases required conversion due to splenic vein tears.
• CDFI accurately depicted splenic pedicle anatomy and vessel-pancreas relationships.
• The CDFI group showed significantly shorter operative times (158.7 vs 200.7 min), less blood loss (55.9 vs 101.8 ml), and faster GI recovery (24.4 vs 30.6 hrs).

Conclusions:

• Preoperative CDFI provides reproducible splenic anatomic frameworks for personalized surgical planning.
• This imaging technique simplifies LS, reduces operative time, minimizes blood loss, and lowers complication risks in splenomegaly cases.