Description

Anecdotal reports of splenectomy date back to the 16th century and by 1920 the Mayo Clinic had reported on splenectomy with operative mortality rates of about 10%. Deletaire originally described laparoscopic splenectomy, in 1991. The laparoscopic approach should be considered as a therapeutic option for all patients undergoing elective splenectomy. A few important contraindications to the laparoscopic approach are patients with liver failure with portal hypertension, ascities or unmanageable coagulopathy. In addition, while laparoscopic management of splenic trauma has been reported in the literature, it is not standard of care, and should not be considered in a patient with hemodynamic instability. It is very important to understand the vascular anatomy of the spleen when planning a splenectomy. The majority of the arterial supply is from the splenic artery, which is one of three major branches off the celiac axis of the aorta. The splenic artery has a serpentine course that crowns the superior boarder of the pancreas. It generally gives off a few pancreatic branches and a branch to the superior pole of the spleen prior to diving into the splenic hilum.