A New Technique for Spleen Resection

Introduction. Currently, the concept of preserving the spleen functions is considered generally acknowledged. Among organ-preserving surgeries involving the spleen, resection of the damaged part of the organ is worth noting. Notably, the use of various resection techniques is limited in some cases due to inefficiency and technical complexity.

The aim of the study was to develop experimentally a novel technique for polar wedge resection of the spleen.

Materials and methods. The study involved 29 human cadavers, 54 rabbits (83 items totally). Five of 29 unfixed spleen sections were studied using histotopographic approach, and 24 were subjected to wedge resection of the poles. An option for wedge resection of the spleen was developed in two versions: ligature and adhesive. Each option was tested on 12 sections of the cadaveric spleen. It was found that the optimal angles for performing resection are 45° and 60°. In the first version of the developed technique (ligature), double-row through U-shaped sutures were used; after the edges were brought together, nodal microsurgical sutures were applied to the spleen capsule. The second version of the developed technique (adhesive) included the use of medical surgical glue "Sulfacrylate" and a single-row nodal microsurgical suture on the capsule. The first version of the new technology was used in the rabbits in the first experimental series, and the second version was used in the laboratory animals in the second experimental series. In the rabbits of the third (control) series, the edges of the spleen pole were sutured with a continuous suture with fixation of the greater omentum. The material obtained after experiments on cadavers and laboratory animals was sent for histotopographical examination.

Results. Under both variants of the new technique, histotopograms of the cadaveric spleen poles demonstrated a juxtaposition of histologically homogeneous layers, and the capsule was defined as a continuous line. Reliable hemostasis was achieved in animals of all series. Histotopograms of the spleen poles of rabbits of the experimental series obtained on the 7th, 14th, and 21st days showed a juxtaposition of histologically homogeneous layers, and the capsule was defined as a continuous line. No postoperative complications were observed. In rabbits of the control series, histotopograms showed no juxtaposition of histologically homogeneous layers on the 7th, 14th, and 21st days after surgery, and capsule deformation was observed. Purulent splenic inflammation in the form of a micro-abscess was observed in 2 of 18 (11.1%) rabbits of this series.

Conclusion. A new technology of the spleen resection has been developed in two variants. The use of the new resection technique ensures reliable hemostasis, precise contact of the surfaces being connected, prevents parenchyma cutting, and allows preserving almost the entire functionally active parenchyma.