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Laparoscopic Splenectomy

Laparoscopic Spleen Removal (Splenectomy)

The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called “macrophages” (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria. The spleen can affect the platelet count, the red blood cell count and even the white blood count.

There are several reasons why a spleen might need to be removed, below are some of the more common reasons:

•  Auto-immune thrombocytopenia purpura (ITP): This is the most common reason. In this disease, a patient’s platelet count is low because the body makes antibodies to the platelets which cause them to be destroyed in the spleen. Since platelets are blood cells which aid in blood clotting, patients are at risk for bleeding. The first line of treatment is medical therapy but when this is not successful, removal of the spleen (splenectomy) can be curative or at least significantly improve the platelet count in the vast majority of cases.

•  Hemolytic anemia: In this disease the body makes antibodies to red blood cells which are subsequently destroyed in the spleen. When medical therapy fails, some patients require spleen removal to prevent or decrease the need for transfusion.

•  Hereditary (genetic) conditions: There are several diseases that affect the shape of red blood cells, such as, spherocystosis, sickle cell disease or thalassemia. In these patients, the spleen recognizes the red cells as abnormal and may bring them down, possibly requiring splenectomy to improve the symptoms.

•  Malignancy: Rarely, patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, require spleen removal. When the spleen gets enlarged, it sometimes removes too many platelets from your blood and has to be removed. Sometimes the spleen is removed to diagnose or treat a tumor.

•  Other reasons: Sometimes the blood supply to the spleen becomes blocked (infarct) or the artery abnormally expands (aneurysm) and the spleen needs to be removed. Rarely, the spleen can become infected and is best treated with removal.

How are These Problems Found?

An evaluation typically includes a complete blood count (CBC), to look at the amount, sizes and shapes of the cells in your blood. Sometimes it is important to get a specimen of bone marrow. The bone marrow is where red cells and other components of the blood are made and can be very helpful to understand the source of the problems. Finally, almost nobody has their spleen removed electively without some imaging  such as an ultrasound, a computerized tomography (CAT scan), or magnetic resonance imaging (MRI). Understanding the size and shape of the spleen is very helpful to understanding the cause of the problem as well as for surgical planning. In addition, sometimes a nuclear scan of the spleen can be helpful especially if little satellites of the spleen known as accessory spleens or “splenules” are suspected.