|
HOW I DO IT / HOW I DID IT SURGICAL PROCEDURES |
|
SPLENECTOMY
§ Patient lying supine § Asepsis/antisepsis § Sterile drapes placed § Midline incision from xiphoid to infraumbilical area § Divide gastrocolic omentum § Divide and ligate the left gastroepiploic vessels § Clamp and ligate splenic artery with 2‑0 silk § Mobilizing the Spleen © Expose splenophrenic and splenorenal ligaments and divide them © Dissect spleen off the capsule of Gerota and the diaphragm © Divide splenocolic ligament § Dissect tail of the pancreas from the posterior wall of the splenic artery and vein § Identify previously ligated splenic artery and ligate it again near the hilus, leaving sufficient stump of splenic artery. Then divide the splenic artery. § Divide the splenic vein near its juncture with the superior mesenteric vein between ligatures of silk 2-0 § Remove the spleen § Search area of pancreatic tail, kidney, gastrosplenic ligament, omentum, small and large bowel mesentery, and pelvis for accessory spleens § Complete and meticulous hemostasis § Irrigate upper abdomen with saline solution § Closure in layers |