Splenectomy (Open, Laparoscopic, Robotic)

Procedure Snapshot

• Indication: ITP, trauma, hereditary spherocytosis.
• Expected duration: ___
• Special instruments: Stapler, laparoscope, bag.

Step Workflow

1. Left lateral decubitus (lap).
2. Mobilize splenocolic & splenophrenic ligaments.
3. Divide short gastrics & splenic vessels at hilum.
4. Inspect accessory spleens.
5. Extract bagged spleen.

Key Pimp Questions

• Q: Vaccines post-splenectomy? Pneumo, Meningo, Hib.
• Q: Accessory spleen locations? Hilum, gastrosplenic ligament, pancreas tail (PMID 30146412).

Critical Anatomy

• Landmarks: Splenic hilum, pancreatic tail.
• Danger zones: Splenic vein injury, pancreatic tail.

Informed Consent Highlights

• Bleeding, pancreatic fistula, OPSI (overwhelming infection).

Post-op Considerations

• Vaccinate 2 weeks post-op; lifelong infection precautions.

References

• Chassin’s, Spleen. Clinical Scenarios, Hematology.
• Rescorla 2018 (PMID 30146412).