The intervention of first choice, or gold standard, as well as the only therapy for most spleen pathologies, is splenectomy.
Splenectomy is the surgical removal of the spleen, which is performed when the organ presents irreparable damage or no longer functions properly. It can be performed in two different ways: with a minimally invasive technique (which can be laparoscopic or robotic) or with a traditional one (or open surgery).
Splenectomy, if it is planned for some time (that is, if it is not an emergency operation), provides for the following preoperative measures:
- Splenectomy is performed under general anesthesia, so it is requested not to eat or drink for several hours before the operation.
- Stop taking certain medicines. In view of the intervention, there are medications that absolutely should not be taken (for example, anticoagulants). For this reason, it is important that the patient communicates to the doctor all the medicines that he is taking or has taken in the recent past.
- Laparoscopic splenectomy is performed as follows: First, the surgeon makes four small incisions in the patient's abdomen; through one of them he slides a tiny video camera that, connected to a monitor, allows him to orient himself during subsequent manoeuvres. Then, through the other three incisions, he drives instruments to isolate and remove the spleen.
- The entire procedure is carried out with the patient positioned on the right lateral side (right lateral decubitus), so that the spleen better "lends itself" to extraction.
During laparoscopic splenectomy, the spleen is first separated from its supporting ligaments and the blood vessels that supply it. These operations are performed in such a way as to minimize bleeding. Subsequently, the organ to be extracted is placed in a kind of bag and extracted. There is also the possibility of crushing it, once in the bag, and removing it piece by piece.
Robotic splenectomy is performed in the same way as laparoscopic; the difference lies in the position of the first surgeon operator who is not on the operating table but sitting on a console connected to the Da Vinci robot. Robot arms, loaded with tools, are inserted through the abdominal incisions and operated remotely by the first operator. The first trader's assistants are instead at the operating table and are in charge of changing instruments if necessary.
Traditional or open splenectomy is the classic surgery to remove the spleen. It is performed after the incision and opening of the upper left part of the abdomen. Once isolated from the vessels and their ligaments, the spleen is carefully removed, taking care not to damage the other adherent organs. After removal, the abdomen is closed with stitches.
After surgery, hospitalization is expected, which can range from a minimum of two days to a maximum of six. The duration of the stay is at the discretion of the treating physician, who decides based on the patient's state of health.
After discharge, it is necessary to fully rest for at least a week. During this period, it is necessary to follow the doctor's advice to the letter.
Full recovery usually occurs within 4 to 6 weeks.