UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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196 Updated Topics in Minimally Invasive Abdominal Surgery This is a biological barrier containing sinus-lining endothelial cells, basement membrane, macrophages, reticular cells, reticular fibers (reticular tissue), and collagen fibers. Endocrine function As an important immune organ, the spleen also has an endocrine function, and is an important part of the immuno–neuro–endocrine modulation system in the body. Normal spleen may secrete erythropoietin, colony-stimulating factor, thyroid–stimulating hormone, gonadotropin, growth hormone, etc. Through the nineteenth and twentieth century splenectomy had been successfully performed for trauma and hypersplenism. It was observed that the patients recovered to their usual pursuits but the life-long probability of the infection, augmented rate of long-term thromboembolic complications, enhanced arteriosclerosis, and late coronary artery disease could not be ignored and the long-term survival seemed skeptic. It’s obvious that the knowledge of spleen function is getting more apparent and deep. Its importance in the host defense and immune function is absolutely undisputed. So the surgeons and researchers came up with the notion of preserving the spleen. To the matter of fact this conception didn’t go in vain as it has been established now that that the preservation of at least 25% of the splenic parenchyma ensures an adequate short and long-term splenic function. The anatomy of the spleen and its surrounding structures is indispensible. At the spleen hilum, all the vascular structures enter and divide to the related poles. Sometimes in patients the vessels divide into three branches thus any injury at the pedicle can result in the ischemia to the part supplied by the other branches(figure 1). Since, there is an ample amount of blood flow through the spleen. So, if the flow is interrupted to the part not being dissected “reperfusion injury” should be well thought-out. If the crisis is in the superior or inferior pole the dissection is not to difficult compared to the crisis at the hilum. The hilum also has the pancreatic tail landing on it; therefore, the activities at the hilum must be with care and precision so as not to injure pancreas. While draining the abscess there is an increased risk of the content to leak and reach the peritoneal cavity that is probable to cause sepsis around. Before starting the dissection of the splenic tissue, its abdominal adherence should be resected with care and after the surgery the remenant spleen should be place carefully to the left upper quadrantto avoid rotation, which further can re-open the cut surface and vessels. The size, location of cysts, abscess, hemangioma and trauma plays an essential role in the decision for choosing the best-suited technique. Spleen injury scale At present, there are dozens of methods for spleen injury scaling. Main methods include Schackford Grade V (1981), Feliciano Grade V(1985), Gall & Scheele Grade IV(1986), Uranus Grade V(1990), American Association for the Surgery of Trauma(AAST, 1994 Revision) Grade V, and Patcher Grade IV(1998) and so on. These methods have different characteristics, but sometimes cannot effectively guide clinical work and operation. The 6th National Symposium on Spleen Surgery of China held in September 2000 in Tianjin adopted the spleen injury scale criteria as below. Grade I: subcapsular splenic rupture whose length ≤ 5.0cm & depth ≤ 1.0cm shown in the surgery. Grade II: the length of the spleen laceration≥5.0cm & depth ≥ 1.0cm, but the splenic hilum is not involved, or segmental splenic vessels are injured. Grade III: splenic rupture involves into splenic hilum, or partial spleen is broken apart, or spleen trabecular vessels are injured. Grade IV: extensive rupture exists in the spleen, or there is an injury in splenic pedicle, and main veins and arteries. Such scaling method helps to quickly determine the injury condition, but cannot cover all
Spleen Preserving Surgery and Related Laparoscopic Techniques damages; so there is a need to make a revision and improvement according to actual situation in clinical work to adjust the treatment. a) b) c) Fig. 1. a) spleen artery is divided four branches into different segment , b) the anatomic basis of preseving spleen , c) model of spleen vessels 197
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UPDATED TOPICS IN MINIMALLY INVASIV
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free online editions of InTech Book
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VI Contents Chapter 9 Appendicitis
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Part 1 Laparoscopic Biliary-Pancrea
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4 Updated Topics in Minimally Invas
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1. Introduction 5 Laparoscopic Live
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Laparoscopic Liver Resection 2.2.1
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Laparoscopic Liver Resection of 64
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Laparoscopic Liver Resection conver
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Laparoscopic Liver Resection (Bruix
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Laparoscopic Liver Resection (Buell
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Laparoscopic Liver Resection House,
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1. Introduction 6 Hilar Glissonean
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Hilar Glissonean Access in Laparosc
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1. Introduction 7 Laparoscopic Live
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Laparoscopic Liver Surgery Fig. 1.
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Laparoscopic Liver Surgery speciali
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Laparoscopic Liver Surgery 3. Imagi
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Laparoscopic Liver Surgery 5 mm por
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Laparoscopic Liver Surgery A nylon
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Laparoscopic Liver Surgery Fig. 7a.
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Laparoscopic Liver Surgery or later
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Laparoscopic Liver Surgery non rand
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Laparoscopic Liver Surgery With rap
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Laparoscopic Liver Surgery [19] Tro
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Laparoscopic Liver Surgery [51] Lai
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Laparoscopic Liver Surgery [84] Les
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Part 3 Laparoscopic Appendectomy
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Page 193 and 194: Laparoscopic Incisional Hernia Repa
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Page 237 and 238: Laparoscopic Approach to Abdominal
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UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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