الفهرس 
ANATOMY OF THE SPLEENOnly 14 pages are availabe for public view
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Abstract
Since 1992, when Delaitre and Maignien described their initial success with Laparoscopic splenectomy, LS has become the preferable option for treatment of various hematological disorders especially in patients with normal-sized spleens (Delaitre et al., 1992).
The indications of splenectomy can categorized as A-non traumatic indications as (1) malignant hematological diseases (e.g. Lymphoma, Leukemia, Myelodysplastic and Myeloproliferative Disorders); (2) benign hematological diseases (e.g. hereditary spherocytosis Autoimmune hemolytic anemia, Sickle cell disease, thalassemia, ITP, and Gaucher’s disease) (3) mass lesions of the spleen (e.g. Abscesses, Cysts and Tumors) (4) Vascular disorders of the spleen and (5) Miscellaneous disorders (e.g. portal hypertension and Felty’s syndrome); and B-traumatic indications: in cases of penetrating trauma, blunt trauma and operative trauma. The indications for performing LS are the same as those for open splenectomy, with few exceptions as traumatic indications. The most common indications are ITP and hereditary spherocytosis (Whitman and Brunt, 2004).
LS plays a limited role in traumatic splenic injuries due to technical limitations in controlling hemorrhage with this approach. Massive splenomegaly (long axis length >25 cm) is a relative contraindication due to difficulties in establishing pneumoperitoneum and adequate working space. Other relative contraindications are splenic artery aneurysm, splenic abscess, portal hypertension, and ascites (Bhandarkar et al., 2011).
LS can be performed by a variety of techniques, the first described was the anterior approach with patient in supine position, then the lateral approach and with patient in lateral position was introduces and became the most widely adopted technique due to the many advantages it offers compared to the previous technique. Recently LS reached the era of robotic surgery, NOTES and single port LS (Trias et al., 1996).
Several modifications in technique should be considered in approaching the patient with splenomegaly like: modifications in the trocar placement, use of additional trocars, open insertion technique, preligation of the splenic artery proximal to the hilum and hand-assisted technique (Feldman et al., 2008).
LS may cause different intraoperative and post operative complications. Intraoperative complications include hemorrhage (the commonest) and injury to adjacent organs. Postoperative complications after splenectomy include: hemorrhage, wound infections, cardiopulmonary complications, subphrenic collection, pancreatitis, thrombosis of the splenic of portal vein and postsplenectomy overwhelming sepsis (Bhandarkar et al., 2011).
There are many advantages for laparoscopic splenectomy. The main advantages are better operative outcomes with shortened period of ileus, hospital stay and decreased analgesic use and the reduction in the rate of major complications. This will help patients to resume their normal activities in a shorter time than open surgery patients (Kenyon et al., 1997).
Laparoscopic splenectomy can be completed safely in about 90% of properly selected patients. The incidence of conversion to open splenectomy is between 0 and 20%. Most of the conversions are caused by intraoperative bleeding, but lack of surgical experience, extensive adhesions, large splenomegaly and obesity are also involved. A significant learning curve is observed with laparoscopic splenectomy, and with increasing experience, the conversion rate has been reported to decrease dramatically (Shelton and Holzman, 2012).