**6. Conclusion**

202 Updated Topics in Minimally Invasive Abdominal Surgery

As the splenic function mentioned above is better understood, spleen surgeries have developed from the early stage of random splenectomy to the second stage of non-selective spleen preserving, and to today's stage of selective spleen preserving. The concept of spleen preserving has become gradually popular, and various procedures to preserve the spleen have been widely applied which has achieved aoptimal result. Current spleen- preserving

1. Hemostasismethods, which involve hemostatic materials (such as gelatin sponge, fibrin tissue adhesive), radiofrequency ablation, argon beam coagulator and other technical

Partial splenectomies can be successfully performed for complication like splenic cyst, splenichemangioma, splenic mass, blunt traumas and splenic cysts. Proper hemostasis and uninterrupted view of the surgical site has always been a surgical concern. With the advent of laparoscopic techniques many flaws have been obviated which makes partial splenectomies more justifiable. The laparoscopic spleen surgeries, which once started with classical four trocarsand electrocautery have evolved to have come long way. The assistance of better HD cameras with robotic zoom in and zoom out function have given the surgeons the most uninterrupted clear view of the surgical site which has bought the ease in locating a structure and active hemostasis. The cameras once used by the fellow operator can now be operated with voice commands and joysticks of the surgeon. The 180degree rotations of the cameras have made the view extremely vivid circumventing accidents. The electro cautery had drawbacks like the eschar formation that have been eliminated with the development of harmonic and plasma scalpels. The harmonic and plasma scalpel and uses of laser prevents escharformation, which prevents postoperative disruption and bleeding. These scalpels works with better precision near the vital structures as the pedicle of spleen. There is minimal thermal tissue damage, which is pivotal for postoperative recovery. The uses of ligatures have become least and the charring and dissication have been minimized. The postoperative healing, pain have also been greatly minimized with lesser hospital stay. A surgeon should choose a specific way depending on experience, overall cost and the simplicity in manipulating instruments. The robotic instruments, the use of harmonic and plasma scalpels in other instance needs a constant technical assistance. Robotic instruments are cumbersome and needs constant upgrading and high cost of compatible instruments prevents worldwide adoption. There is also an operative time delay when using robotics

Laser in the other hand has the advantage of checking blood loss, sealing the most small blood vessels, ability to work in relatively dry field which facilitates visibility, minimum tissue trauma less pain, edema (due to sealing of nerve endings and lymphatics) decreases chance of malignant cells to spread, scarring due to precision and most importantly decreases stenosis which is appropriate for splenic hemangiomas. The use of laser needs a surgical technologist (ST) at all times as its failure during the surgery can cause panic. Strict safety precautions must be enforced, eye protection for patients and all personnel in the room is mandatory for most lasers and flammable prep solutions and other flammable

**5. Discussion** 

methods are mainly as follows:

2. Suture repair for ruptured spleen.

and it needs special training to surgeons.

equipment.

3. Partial splenectomy. 4. Spleen autotransplantation. 5. Selective arterial embolization.

> A laparoscopic spleen preserving surgery as aforementioned is a technically demanding procedure. The spleen parenchyma is frail and the tears or the parenchymal bleeding can occur. Thus, from a surgeon's point of view it requires exquisite care and control to avoid parenchymal rupture and cell spillage. There are many techniques available to do the same procedure in a logical and proficient way. The surgeons must be familiar with all the details and complications before choosing for one. Every technique has a virtue of its own over the other, so it is vital to discriminate techniques to choose the ideal one. The need of the laparoscopic surgery must be understood with the operative time and cost in mind. The postoperative outcome is the most important part of perioperative care and in the abdominal surgeries as spleen; adhesion is serious complication that affects the motility of abdominal structures later on. The complication as eschar formation, which may disrupt postoperatively is capable of causing bleeding. Thus, the technique that offers minimum adherence, eschar formation, sepsis, and necrosis should be employed.

**13** 

**Gastric Volvulus** 

Claude Avisse2, Hugues Ludot3,

*1Department of Pediatric Surgery* 

*2Department of Anatomy 3Department of Anesthesiology* 

*University of Medicine* 

*France* 

**Laparoscopic Gastropexy for the Treatment** 

Wandering spleen is a rare condition. This congenital or acquired pathology is found in children and adults alike. It is characterized by a hypermobile spleen causing in some cases

We will successively look at the anatomy, etiologies, epidemiology, clinical pictures,

Wandering spleen is caused by failed fusion of the dorsal peritoneum, or absence or abnormal development of its suspensory ligaments that hold the spleen in its normal

The splenic ligaments are the gastrosplenic, splenorenal (splenopancreatic), splenophrenic,

Embryologically, the splenic ligaments develop in the coeliac artery territory, from the primitive dorsal mesentery (mesogastrium), which is responsible for the formation of peritoneum, the greater omentum and the several peritoneal folds. However, developmental anomalies or variations may take place. These variations in the embryologic development of

These ligaments may be absent, may be too long or too short, too wide or too narrow, or

additional imaging examinations and surgical possibilities for this pathology.

the spleen's primary supporting ligaments could explain the wandering spleen.

**1. Introduction** 

**2. Anatomy** 

abnormally fused.

**3. Etiology** 

splenic torsion with ischemia.

position in the left upper quadrant of the abdomen.

Wandering spleen can be a congenital or acquired condition.

splenocolic ligaments. (Couinaud, 1963)

**of Wandering Spleen With or Without** 

Mohamed Belouadah1 and Marie-Laurence Poli-merol1

Caroline Francois-Fiquet1,Yohann Renard2,

*American Memorial Hospital CHU REIMS / REIMS* 

### **7. References**

