Related Experiment Video
Updated: Aug 2, 2026
Bloodless Laparoscopic Partial Splenectomy Assisted by Bipolar Radiofrequency Excision Hemostatic Device
Published on: November 4, 2022
Laparoscopic Subtotal Splenectomy in Pediatric Patients With Hematologic Disorders: A Case Series and Operative
Masaya Yamoto1,2, Yu Sugai2, Yuri Nemoto2
1Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan.
Insights
Laparoscopic subtotal splenectomy (LSS) in children safely preserves spleen function, reducing the risk of overwhelming post-splenectomy infection (OPSI). This spleen-preserving surgery is a viable option for pediatric patients with hematologic disorders.
Area of Science:
- Pediatric Surgery
- Hematology
- Immunology
Background:
- Total splenectomy in children elevates the risk of overwhelming post-splenectomy infection (OPSI).
- Laparoscopic subtotal splenectomy (LSS) offers a method to preserve spleen function while addressing disease burden in pediatric hematologic conditions.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic subtotal splenectomy (LSS) in pediatric patients.
- To assess the preservation of splenic function and reduction of OPSI risk following LSS.
Main Methods:
- LSS was performed on three pediatric patients (ages 4-9) with juvenile myelomonocytic leukemia or hereditary spherocytosis.
- Indocyanine green (ICG) fluorescence imaging guided intraoperative assessment of splenic perfusion.
- Approximately 90-97% of the spleen was resected, preserving a small remnant.
Main Results:
- All patients recovered well with no instances of OPSI.
- ICG imaging facilitated safe resection and maintained perfusion in the splenic remnant.
- No cases of splenosis or need for completion splenectomy were observed during follow-up.
Conclusions:
- Laparoscopic subtotal splenectomy (LSS) is a feasible and safe surgical option for select pediatric patients.
- LSS effectively minimizes the risk of OPSI while preserving crucial immunologic functions of the spleen.
- This spleen-preserving approach is beneficial for managing pediatric hematologic disorders.
Introduction:
Total splenectomy in children increases the risk of overwhelming post-splenectomy infection (OPSI). Laparoscopic subtotal splenectomy (LSS) is a technique to preserve splenic function while managing disease burden in pediatric hematologic disorders.
Materials And Surgical Technique:
Three children aged 4 to 9 years with juvenile myelomonocytic leukemia (JMML) or hereditary spherocytosis underwent LSS. All received pneumococcal vaccination and preoperative CT imaging. Under general anesthesia, three 5-mm trocars were used. Intraoperative indocyanine green (ICG) fluorescence imaging guided perfusion assessment. In one case, an upper pole was preserved due to anatomical considerations. In two cases, LSS was combined with laparoscopic cholecystectomy. Approximately 90 to 97% of the spleen was resected, leaving a 30 mL remnant.
Discussion:
All patients recovered well without OPSI. One case required transfusion. ICG imaging enabled safe resection with preserved perfusion. No case developed splenosis or required completion splenectomy during follow-up. LSS is a feasible technique for selected pediatric patients to minimize infection risk while maintaining immunologic function.
