**3. Laparoscopic surgery in spleen-preserving surgery**

Carroll et al reported the laparoscopic splenectomy for the first time in 1992. Since then, the laparoscopic surgery has extended to the traditional fields covered by laparotomy, e.g. spleen adhesion, splenorrhaphy, artery ligation, partial splenectomy and the like, and has been combined with such new techniques as LigaSure, splenic arterial embolization, CUSA, radiofrequency ablation, thus adding a new vitality to the spleen-preserving surgery. The laparoscopic spleen-preserving surgery is somehow difficult, time-consuming, and costly. However, when compared to laparotomy, this surgery has more advantages, for example, clear operative field, minimal invasion, rapid recovery, and short hospital stay.

Laparoscopic inspection: To determine the extent and scope for splenic injuries or lesions; to understand injuries or lesions in the surrounding tissues or organs of spleen; to judge the extent for the bleeding area and vascular injuries; to carry out the pathological examination for the spleen or the surrounding tissues and organs under direct vision biopsy.

The laparoscopic spleen-preserving surgery has the following indications: Grade I-II splenic injuries with hemodynamic and vital sign stability; local benign lesions in the spleen, e.g. splenic cyst, splenichemangioma, echinococcosis, and etc.; hypersplenia, e.g. portal vein hypertension, hereditary spherocytosis and etc.; perisplenic tumors, e.g. pancreatic tumor, gastric cancer and etc.; splenic congenital diseases, e.g. splenectopia, accessory spleen and so on. Contraindications: Grade IVsplenic injuries; severe portal hypertension; splenomeglia; severe coagulopathy.

The spleen-preserving surgery is similar to the laparotomy:


In the laparoscopic spleen-preserving surgery, the complications include hemorrhage, visceral injury, infection, splenic vein thrombosis and so on.

The laparoscopic spleen-preserving surgery is still in trial stage, and its efficacy is uncertain. Clinically, we should not blindly pursue new technology ignoring its efficacy; instead, we should never forget the damage control principles for splenic surgery, always save life first, and then deal with the injury.

In the current study, the spleen function is not very clear, but we begin to know it can play an important role in human body. Spleen-preserving surgeries have been widely implemented. Moreover, the extensive laparoscopic application has brought new opportunities, making the future splenic surgery more scientific and reasonable.
