The surgical method for spleen removal (splenectomy) is a closed (laparoscopic) technique (except for cases such as excessive spleen enlargement and bleeding). In closed surgery, no large incision is made in the abdomen, all procedures are performed with rod-shaped instruments inserted into the abdomen through small holes. Complete anesthesia (general anesthesia) is preferred for surgery.
The essence of the procedure is; Following the release of the bonds between the spleen and surrounding structures, the organ is completely removed by closing and separating the main vessels of the spleen by methods such as sealing and stapling.
The patient is operated on in a lying position on his right side. First, a small tube is inserted into the abdomen near the left rib arch and the abdominal cavity is inflated with approximately 4 liters of gas. Then, a rod-shaped camera passing through this pipe is sent into the abdomen and the view inside is reflected on the television screen.
Two or three smaller ones are placed under the left rib arch. The tube is placed and rod-shaped surgical instruments are inserted into the abdomen. The surgeon performs the surgery by watching the organs in the abdomen, the instruments he uses and the procedures he performs on the screen.
During the surgery, first the connections of the spleen with the large intestine, stomach, diaphragm and the left kidney are removed by vessel sealing devices (harmonic scalel). It is separated using ligasure (electrocautery). At this time, the splenic artery can be found and ligated. Then, the main vascular structures (spleen hilus) on the inner surface of the spleen - located in close proximity to the tail of the pancreas - are closed and separated using staples or sealing methods, and the spleen is freed in the abdomen.
The spleen, which is usually the size of a fist, is closed and separated. Removing the spleen through one of the small holes requires a special technique. For this purpose, a nylon bag (endobag) folded in a tube-shaped handle is used. The end of the endobag is inserted into the abdomen and the bag is opened in the abdomen. The spleen is placed in a bag. The mouth of the bag is tightened with a previously prepared rope. The mouth of the bag is taken out from the 1.5 cm hole and opened outside. With instruments inserted through this mouth, the spleen is cut into small pieces and taken out. finally emptied The bag is taken out.
When the procedure is completed, the gas in the abdomen is completely evacuated and the small incisions are closed with hidden stitches and the surgery is completed.
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