1
|
Roy P, Mukherjee R, Parik M. Splenic trauma in the twenty-first century: changing trends in management. Ann R Coll Surg Engl 2018; 100:1-7. [PMID: 30112955 PMCID: PMC6204520 DOI: 10.1308/rcsann.2018.0139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 12/16/2022] Open
Abstract
Over the past three decades, management of blunt splenic trauma has changed radically. Use of improved diagnostic techniques and proper understanding of disease pathology has led to nonoperative management being chosen as the standard of care in patients who are haemodynamically stable. This review was undertaken to assess available literature regarding changing trends of management of blunt splenic trauma, and to identify the existing lacunae in nonoperative management. The PubMed database was searched for studies published between January 1987 and August 2017, using the keywords 'blunt splenic trauma' and 'nonoperative management'. One hundred and fifty-three articles were reviewed, of which 82 free full texts and free abstracts were used in the current review. There is clear evidence in published literature of the greater success of nonoperative over operative management in patients who are haemodynamically stable and the increasing utility of adjunctive therapies like angiography with embolisation. However, the review revealed a lack of universal guidelines for patient selection criteria and diagnostic and grading procedures needed for nonoperative management. Indications for splenic artery embolisation, the current role of splenectomy and spleen-preserving surgeries, together with the place of minimal access surgery in blunt splenic trauma remain grey areas. Moreover, parameters affecting the outcomes of nonoperative management and its failure and management need to be defined. This shows a need for future studies focused on these shortcomings with the ultimate aim being the formulation and implementation of universally accepted guidelines for safe and efficient management of blunt splenic trauma.
Collapse
Affiliation(s)
- P Roy
- RG Kar Medical College and Hospital, General Surgery, Kolkata, India
| | - R Mukherjee
- RG Kar Medical College and Hospital, General Surgery, Kolkata, India
| | - M Parik
- RG Kar Medical College and Hospital, General Surgery, Kolkata, India
| |
Collapse
|
2
|
Laparoscopic radiofrequency ablation for traumatic splenic rupture. J Surg Res 2013; 185:711-6. [DOI: 10.1016/j.jss.2013.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 11/17/2022]
|
3
|
Singh AK, Shankar S, Gervais DA, Hahn PF, Mueller PR. Image-guided percutaneous splenic interventions. Radiographics 2012; 32:523-34. [PMID: 22411947 DOI: 10.1148/rg.322115135] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.
Collapse
Affiliation(s)
- Ajay K Singh
- Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
| | | | | | | | | |
Collapse
|
4
|
A new technique for partial splenectomy with radiofrequency technology. Surg Laparosc Endosc Percutan Tech 2012; 21:358-61. [PMID: 22002274 DOI: 10.1097/sle.0b013e31822f3889] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The advantage of partial splenectomy is the preservation of its immunologic function. In this series, 8 patients underwent a spleen preservation procedure with radiofrequency. Four of the partial splenectomy procedures were performed in elective situations, whereas the other 4 cases were performed to control traumatic bleeding in emergency situations. A harrow-like radiofrequency probe with 6 needles was applied to the spleen, and the division of the splenic parenchyma was completed using a surgical scalpel through the midline of the ablated tissue. This safe, fast, and simple technique allows for preservation of splenic function with minimum blood loss.
Collapse
|
5
|
Radiofrequency fulguration of␣the␣spleen under␣laparoscopy to␣stop iatrogenic hemorrhage. Surg Endosc 2011; 26:1163-4. [DOI: 10.1007/s00464-011-2010-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 10/14/2011] [Indexed: 11/25/2022]
|
6
|
Microwave ablation in the spleen for treatment of secondary hypersplenism: a preliminary study. AJR Am J Roentgenol 2011; 196:692-6. [PMID: 21343515 DOI: 10.2214/ajr.10.4193] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the feasibility, safety, and efficacy of microwave (MW) ablation for the treatment of hypersplenism, via a laparoscopic or percutaneous approach, and its effect on liver function in patients with liver cirrhosis. SUBJECTS AND METHODS Twenty patients (17 men and three women; mean age, 51.7 ± 11.4 years; age range, 31-68 years) with secondary hypersplenism resulting from liver cirrhosis were treated with MW ablation of splenic parenchyma (13 laparoscopically and seven percutaneously with ultrasound guidance). Splenic volume and ablated volume were calculated according to contrast-enhanced CT scan. Routine blood counts (platelet, leukocyte, and erythrocyte counts) and liver function test results were examined before and after MW ablation. RESULTS The mean follow-up period was 26.4 ± 11.4 months (range, 6-48 months). After MW ablation, the ablation ratio ranged from 16% to 58% (mean, 30.9% ± 13%). All patients showed an increase in platelet count and leukocyte count after MW ablation, and patients with an ablation ratio greater than 40% showed more sustainable increase of platelet count in the follow-up period. Serum total protein levels significantly increased (p < 0.05). No severe complications occurred. CONCLUSION MW ablation is a safe and effective technique for the management of hypersplenism in patients with liver cirrhosis. Ablating more than 40% of the splenic parenchyma may yield better long-term results.
Collapse
|
7
|
Karadayi K, Turan M, Sen M. New partial splenectomy technique using radiofrequency ablation technology. SURGICAL PRACTICE 2010. [DOI: 10.1111/j.1744-1633.2010.00503.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Zacharoulis D, Lazoura O, Sioka E, Tzovaras G, Rountas C, Spiropoulos S, Zahari E, Chatzitheofilou C. Radiofrequency-Assisted Hemostasis in a Trauma Model: A New Indication for a Bipolar Device. J Laparoendosc Adv Surg Tech A 2010; 20:421-6. [DOI: 10.1089/lap.2009.0324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
| | - Olga Lazoura
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | - Eleni Sioka
- Department of Surgery University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of Surgery University Hospital of Larissa, Larissa, Greece
| | - Christos Rountas
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | | | - Eleni Zahari
- Department of Surgery University Hospital of Larissa, Larissa, Greece
| | | |
Collapse
|
9
|
Radiofrequency ablation of the spleen in patients with thalassemia intermedia: a pilot study. AJR Am J Roentgenol 2009; 192:1425-9. [PMID: 19380572 DOI: 10.2214/ajr.08.1382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We investigated the efficacy and safety of radiofrequency ablation on the hematologic parameters in patients with thalassemia intermedia (TI). MATERIALS AND METHODS Radiofrequency ablation of the spleen was performed in 15 children with TI under general anesthesia using a cool-tip radiofrequency probe. These patients were regarded as the radiofrequency ablation group. Nine patients with TI who underwent partial splenectomy during the past 3 years and another 14 patients with TI who underwent total splenectomy were also enrolled in this study as the first and second control groups (CG1 and CG2). RESULTS In the radiofrequency ablation group, two (13%) patients showed a significant increase in the mean hemoglobin level compared with the year before (1.5 and 1.8 g/dL). In addition, three (20%) other patients became transfusion-free in the year after radiofrequency ablation. In CG1, one (11%) patient showed a significant increase in hemoglobin the year after partial splenectomy, and another two (22%) patients became transfusion-free. In CG2, six (43%) patients revealed a significant increase in hemoglobin in the year after total splenectomy, and another four (29%) revealed a significant decrease in the need for transfusions. The mean increase in hemoglobin and platelet count was more significant in CG2 than in the radiofrequency ablation group and CG1. The mean hospital stay was significantly shorter in the radiofrequency ablation group (1.7 days vs 7.5 and 8.2 days in CG1 and CG2, respectively). CONCLUSION We believe that radiofrequency ablation of the spleen can be a safe procedure in patients with TI and is at least as effective as partial splenectomy, having only minor self-limiting complications.
Collapse
|
10
|
Video-assisted lung resection using radiofrequency ablation in a porcine model. J Surg Res 2008; 154:279-83. [PMID: 19376530 DOI: 10.1016/j.jss.2008.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/24/2008] [Accepted: 06/03/2008] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to assess the feasibility, efficacy, and safety of video-assisted lingula resection using radiofrequency ablation (RFA) with internally cooled electrodes in a porcine model. MATERIALS AND METHODS Six domestic pigs underwent RFA-assisted thoracoscopic lingulectomy. RFA was the only aerostatic and hemostatic method applied throughout the operation. After 30 d, the animals were sacrificed for the study of the macroscopic and microscopic effects of the technique. RESULTS No signs of pneumothorax, blood loss, or infection were observed up to 1 mo postoperatively. There was no mortality either during or after surgery. The histopathology of the lung revealed three clearly demarcated zone lesions. CONCLUSIONS Our study demonstrates that thoracoscopic lingulectomy using RFA energy is technically feasible. RFA energy is an effective and safe aerostatic and hemostatic method in the porcine model.
Collapse
|
11
|
Papaconstantinou I, Kontos M, Prassas E, Karavokyros J, Bakoyiannis C, Pikoulis E, Safioleas M, Giannopoulos A, Bastounis E, Felekouras E. Radio Frequency Ablation (RFA)-assisted Pericystectomy for Hepatic Echinococcosis. Surg Laparosc Endosc Percutan Tech 2006; 16:338-41. [PMID: 17057576 DOI: 10.1097/01.sle.0000213702.56569.3f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to describe an alternative technique, using radio frequency energy to perform pericystectomy for hepatic echinococcosis. We present 3 patients with hepatic echinococcosis who were treated with radio frequency ablation (RFA)-assisted pericystectomy. A Radionics Cooltip Radio Frequency System (Tyco, Greece, Radionics) with a single shaft 15 cm long needle electrode and a 2 cm exposure tip, was used. The needle electrode was inserted in consecutive sites into the "healthy" hepatic parenchyma close to the cyst wall, so that a tissue zone around the cystic cavity was gradually ablated. The complete ablation of a site was followed by sharp division of the parenchyma. The operation completed successfully in all patients. Minor bleeding and/or bile leakage were successfully controlled with RFA coagulation. No other hemostatic method was used. The postoperative course was uneventful. No evidence of recurrent disease, or any other cause of morbidity, has been demonstrated at follow up (2 y). RFA-assisted pericystectomy for hepatic hydatid disease in experienced hands, might be useful to perform a "sterile" resection, eradicating single or multiple cysts and preventing local recurrence, with minimal morbidity.
Collapse
Affiliation(s)
- Ioannis Papaconstantinou
- First Surgical Department, Medical School, Athens University, Laikon Hospital, Ag. Thomas 17 Str, 11527, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Radiofrequency ablation (RFA) is an innovative technique used primarily for the palliative treatment of unresectable liver tumors. Its therapeutic indications however, have been expanded and now include various other organs and diseases. There is a paucity of data regarding technical details and complications of the use of RFA in the spleen. We report a case of partial splenectomy using radiofrequency ablation for splenic hydatid disease, complicated by an abscess formation.
Collapse
Affiliation(s)
- Dimitris Zacharoulis
- University of Thessaly, University Hospital of Larissa, Mezourlo, Larissa 41222 Greece.
| | | | | |
Collapse
|
13
|
Felekouras E, Papaconstantinou I, Pikoulis E, Kontos M, Georgopoulos S, Papalois A, Diamantis T, Bramis J, Papalambros E, Bastounis E. Laparoscopic liver resection using radio frequency ablation in a porcine model. Surg Endosc 2005; 19:1237-42. [PMID: 16132328 DOI: 10.1007/s00464-004-2260-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 03/17/2005] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of this study was to assess the feasibility, efficacy, and safety of laparoscopic left lateral lobe resection, using radiofrequency ablation (RFA) with internally cooled tip electrodes, in a porcine model. METHODS Eight domestic pigs underwent left lateral hepatic lobectomy. RFA was the sole hemostatic method applied throughout the entire operation. After 0, 7, 30, or 120 days the animals were killed in order to study the macroscopic and microscopic findings on the liver edge. RESULTS An average of 90 min was enough for the entire operation. No signs of blood loss or infection were observed up to 4 months postoperatively. There was no mortality either during or after surgery. The pathology of the liver revealed the three zone lesions. CONCLUSION Our study demonstrates that laparoscopic left lateral lobectomy using RFA is technically feasible hi the porcine model and is proved to be highly effective and safe hemostatic method.
Collapse
Affiliation(s)
- E Felekouras
- First Surgical Department, Athens University Medical School, Laikon Hospital, Ag. Thomas 17 Str, Athens, 11527, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Pikoulis E, Felekouras E, Papaconstantinou I, Kontos M, Prassas E, Griniatsos I, Bacoyiannis C, Pappa P, Papalois A, Tsigris C, Giannopoulos A, Papalambros E, Bramis J, Bastounis E. A novel spleen-preserving laparoscopic technique using radiofrequency ablation in a porcine model. Surg Endosc 2005; 19:1329-32. [PMID: 16228858 DOI: 10.1007/s00464-004-2219-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 03/17/2005] [Indexed: 12/17/2022]
Abstract
BACKGROUND Partial splenectomy is considered to be the optimal management for a variety of diseases. At the same time, laparoscopic procedures are increasingly used because they present certain advantages against their open counterparts. In this study, the safety and efficacy of radiofrequency ablation (RFA) were evaluated in laparoscopic partial splenectomy performed in a pig model. METHODS Eight domestic pigs were used. Four abdominal trocars were inserted under general anesthesia and the spleen was stabilized with laparoscopic clamps. A RFA needle electrode was inserted transcutaneously, and coagulative necrosis of a zone of the splenic parenchyma between the body and the lower pole was performed. Bloodless sharp division and removal of the lower pole followed. After 0, 7, 30, or 120 days, the animals were killed and examined. RESULTS Blood loss and operation time were minimal. Mortality and morbidity were zero. No abnormal findings were encountered during the postmortem abdominal exploration. CONCLUSION This study demonstrates the feasibility, safety, and efficacy of laparoscopic RFA-assisted partial splenectomy. The RFA-assisted laparoscopic partial splenectomy adds a novel technique to the surgeon's armamentarium for the preservation of a part of the spleen.
Collapse
Affiliation(s)
- E Pikoulis
- First Department of Surgery, University of Athens, Laiko General Hospital, 11527, Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|