3D virtual rendering before laparoscopic partial splenectomy in children.

INTRODUCTION Partial splenectomy in children is a good surgical option for hematological diseases and focal splenic tumors because it allows the preservation of the spleen's immunological function. Furthermore, it can be performed by laparoscopy in children as it is a safe procedure, offering the benefits of a minimally invasive approach. MATERIALS AND METHODS The software VR-render LE version 0.81 is a system that enables the visualization of bidimentional 3D images with magnification of anatomical details. We have applied this system to five cases of non-parasitic splenic cysts before laparoscopic partial splenectomy. RESULTS The images obtained with VR rendering software permitted the preoperative reconstruction of the vascularization of the splenic hilum, allowing the surgeon safe vessel control during laparoscopic procedures. All five partial splenectomies were carried out with no complications or major blood loss. CONCLUSIONS Laparoscopic partial splenectomy should be a first choice procedure because it is feasible, reproducible, and safe for children; furthermore, it preserves enough splenic tissue thereby preventing post-splenectomy infections. Volume rendering provides high anatomical resolution and can be useful in guiding the surgical procedure.

[1]  M. Siegel Multiplanar and three-dimensional multi-detector row CT of thoracic vessels and airways in the pediatric population. , 2003, Radiology.

[2]  R. Bergamaschi,et al.  Laparoscopic partial splenectomy , 2006, Surgical Endoscopy.

[3]  R. Schilling Spherocytosis, splenectomy, strokes, and heart attacks , 1997, The Lancet.

[4]  P. Jain,et al.  Laparoscopic partial splenectomy for splenic epidermoid cyst. , 2008, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[5]  P. Rohrlich,et al.  Follow-up of partial splenectomy in children with hereditary spherocytosis. , 2002, Journal of pediatric surgery.

[6]  S. Engum,et al.  Laparoscopic Splenectomy Has Become the Gold Standard in Children , 2002, The American surgeon.

[7]  M. Kanter,et al.  Hepatoprotective effects of Nigella sativa L and Urtica dioica L on lipid peroxidation, antioxidant enzyme systems and liver enzymes in carbon tetrachloride-treated rats. , 2005, World journal of gastroenterology.

[8]  M. Ziegler,et al.  Partial splenectomy: the preferred alternative for the treatment of splenic cysts. , 1989, Journal of pediatric surgery.

[9]  O. Reinberg Partial Splenectomies by Laparoscopy in Children , 2008 .

[10]  R. Sonnino,et al.  Splenic cysts: aspiration, sclerosis, or resection. , 1989, Journal of pediatric surgery.

[11]  R. Schlinkert,et al.  Hemangioma of the spleen: Presentation, diagnosis, and management , 2000, Journal of Gastrointestinal Surgery.

[12]  Jason C. Fisher,et al.  Recurrence after laparoscopic excision of nonparasitic splenic cysts. , 2008, Journal of pediatric surgery.

[13]  L. Morgenstern Nonparasitic splenic cysts: pathogenesis, classification, and treatment. , 2002, Journal of the American College of Surgeons.

[14]  A. Szczepanik,et al.  Partial Splenectomy in the Management of Nonparasitic Splenic Cysts , 2009, World Journal of Surgery.

[15]  K. Bax Endoscopic surgery in infants and children , 2008 .

[16]  H. Volk,et al.  Immune restoration in children after partial splenectomy. , 1993, Immunobiology.

[17]  D. Kalfa,et al.  Laparoscopic Partial Splenectomy: Indications and results of a multicenter retrospective study , 2007, Surgical Endoscopy.

[18]  W. Davros,et al.  Preoperative use of 3D volume rendering to demonstrate renal tumors and renal anatomy. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[19]  E. Misiakos,et al.  Non-parasitic splenic cysts: a report of three cases. , 2005, World journal of gastroenterology.

[20]  J. Langer,et al.  Laparoscopic versus open splenectomy in children. , 2000, Journal of pediatric surgery.