Benign Blood Disorder Treated with Minimally Invasive Surgery

Immune Thrombocytopenic Purpura

"Hands-free" or laparoscopic removal of the spleen may be the best treatment option for individuals with certain blood disorders, say experts at Baylor College of Medicine in Houston.

Immune Thrombocytopenic Purpura is a blood disorder in which the body's immune system attacks and destroys blood platelets, cells that prevent bleeding by forming blood clots. Due to the decrease in blood platelets, individuals with ITP often bruise and bleed easily. Because the spleen is the main site of platelet destruction, removal of the spleen, a procedure known as a splenectomy, is often necessary. According to experts, ITP, which tends to affect younger women, is the most common cause of a splenectomy.

Traditionally, splenectomies have been performed through open surgery, an invasive procedure that prolongs hospital stay and recovery. Recently, however, a laparoscopic method of the surgery has gained popularity.

"A splenectomy is a procedure that is ideally suited to be done laparoscopically," said Dr. John Sweeney, associate professor of surgery and chief of the General Surgery Division of the Michael E. DeBakey Department of Surgery at BCM. "Unlike other procedures that remove and reconstruct tissue, a splenectomy only entails extraction of the spleen."

The spleen, which is located under the left rib cage, has several functions. It acts as a filtering system for the body by destroying foreign particles in the blood and also protects the body against certain bacteria. Although the body benefits from these purposes, Sweeney, who currently performs 30 splenectomy procedures laparoscopically at BCM each year, says patients can live a normal life without a spleen.

"The body's other immune systems will compensate for the spleen's absence," he said. "However, patients must be vaccinated against certain infections before surgery."

During the operation, four small incisions are made under the left rib cage. Using long surgical instruments, a camera and a video monitor, the spleen is removed and the incisions are closed.

"The patient is usually required to stay in the hospital for a couple of days, but is back to normal activities within a couple of weeks," said Sweeney.

05/06/2005