Laparoscopic splenectomy?

  1. My nephew is having life threatening low platelet counts r/t his spleen abnormally destroying them. Anyway, they want to do it laparoscopically which got me to thinking...

    How do they get a spleen out of tiny incisions? If I calculated correctly a normal spleen is approximately 3x5"

    Do they destroy it inside the body or WHAT? ::scratching head::

    Help a clueless student!
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  2. 9 Comments

  3. by   shodobe
    They use what is called a "lap Disc". The surgeon makes an approx 2-3" incision in the abd and this item has a membranous fillament that he can put his hand through and manipulate the spleen or kidney or whatever. It is a little hard to describe here but we use it on Lap Nissens and it works great. The disc rotates and has the ability to close around the surgeons hand thus eliminating gas leaks.
  4. by   Mommy TeleRN
    Thanks shodobe..trying to picture it... so he is able to stick a few fingers in and manipulate it out through the 2-3" incision? How big would an open incision be for a splenectomy? Oh I wish I could observe some surgeries LOL for now I guess I'll keep watching on the internet. I need to watch some of those medical shows on TV like what Discovery Health or something? LOL

    So far I've only gotten to do clinical on Med/Surg floor. I feel like there is a huge world of nursing out there I wanna delve into!
  5. by   shodobe
    I am holding one right now and will try to describe it. The disc has two solid plastic rings about 4.5 inches in diameter. The incision is about 2-3 inches and will stretch when needed. The ring is inserted so it oocupies the peritoneum area. The two rings are connected with a thin plastic material that when stretched between the rings form a tunnel. Now, when the rings are placed on top of each other and twisted the plastic tunnel becomes more narrow. The surgeon can place his whole hand through this disc and grasp the spleen and dissect it out and remove it through the disc. In some cases if the spleen is two big then it may have to be cut in half to remove it. I hope this is a little better description. The item is made by a Japanese firm and distributed thru Ethicon. Mike
  6. by   amy3072
    I had a splenectomy in 1999 ( the old fashion way)( ITP) I have a 8 inch scar across my abdomen. I was shocked when I saw it.
  7. by   Mommy TeleRN
    Wow Amy..I bet that was shocking

    Shodobe... I was able to google it and see what it looks like (gotta love google images!) Amazing how the skin will accomodate the disc with such a small incision.

    Here are the pics in case anyone is in my boat and hasn't learned about these things LOL

    http://images.google.com/imgres?imgu...lr%3D%26sa%3DN

    http://images.google.com/imgres?imgu...lr%3D%26sa%3DN
  8. by   elisabeth
    I had chronic ITP and my spleen was removed in January 1993 when I was 15. My incision is 8.5 inches. My platelet count rallied immediately though!



    Elisabeth
  9. by   shodobe
    Good picture and it works well, especially if the surgeon has small hands. Mike
  10. by   twinmomoftwins
    I had my lap splenectomy in May. Different though - probably due to it's size - engorged with 500cc of blood r/t condition called wandering spleen-it was all twisted up. The doc placed my spleen in a bag, within my abdomen, pulverized and sucked it out via a tiny 1 inch lap site. Sounds gross, but recovery was a breeze!!:hatparty:
  11. by   kimballina
    Our surgeons do it the same way as stated by twinmomoftwins. They place the spleen into whats called an endocatch (its like a bag on a stick!)and mush the spleen up and then remove by suction (or a grasper for the bits that refuse to break up any further!!) I've seen huge spleens done this way,so size doesn't seem to matter. Again done through the 10 mm port. They are the same incisions as for a lap chole!!!

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