What is the spleen?
This dark purple, bean shaped organ is located in the upper left-hand side of the abdomen, just under the lower ribs. One of the primary functions of the spleen is filtering the blood. Each day our entire blood volume filters through the spleen as bacteria, foreign materials and even tumor cells are sifted out and removed if needed by the guarding action of this secondary lymph gland. In addition, the spleen also functions to hold blood platelets in healthy adults.

What conditions require a splenectomy?
The spleen may be removed, or cease to function normally, for a number of reasons. While the spleen is not required to sustain life, we know that its role in preventing infection is important enough that when possible, the undamaged portion can be preserved.

• Idiopathic thrombocytopenic purpura (ITP). ITP is an autoimmune disease involving platelet destruction. Steroids are used to medically treat this condition, but this weakens the patient and sometimes doesn't effect the autoimmune response enough. Splenectomy is effective in about 70 percent of chronic ITP cases.
• Trauma. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. In this situation, every attempt is made to preserve a portion of the spleen.
• Abscesses in the spleen. These are relatively uncommon but have a high mortality rate. An abscess can sometimes be drained using percutaneous CT (using a needle through the skin to drain the fluid assisted by advanced imaging). This less invasive technique is considered before a surgical alternative is employed.
• Aneurysm (an out pouching) of the splenic artery. Again, every attempt is made to preserve some splenic functioning, if possible, by tying off the splenic artery.
• Some forms of leukemia, such as HCC (Hairy Cell Carcinoma)
• Hypersplenism- that is a group of symptoms that includes an enlarged spleen, defective blood cells and a high blood cell turnover rate. Mononucleosis can cause enlargement of the spleen.
• Malignancy
• Thalassemia, sickle cell

Diagnosis
A normal spleen is not palpable; therefore a spleen that is found on physical examination should definitely be followed with appropriate diagnostic studies. Depending upon your history and symptoms, a number of tests may be ordered, but would likely include splenic scans. A consultation of a hematologist and/or oncologist should be made, and when the specialists have reached an agreement that a splenectomy would be beneficial, surgery can be utilized.

What if I need Surgery?
CVLS always initiates surgery using the laparoscopic approach. In our experience, we have not needed to convert a splenectomy into a long incision, open procedure. Size of the spleen becomes the factor that can preclude laparoscopic approach. The spleen must be reduced internally to allow removal of the tissue. To do so requires utilizing special pouches, which hold the spleen as it is being reduced. Then, the surgeon can extract the pouch holding the splenic tissue, through the small incision.

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