GYO Surgery Series: Splenectomy

Introduction

• Series covers individual surgeries in gynecologic oncology (GYO).
• Includes photos and handmade drawings.
• Focus on splenectomy (removal of the spleen).
• Intended for educational purposes only, not medical advice.

Importance in Ovarian Cancer

• Splenectomy may be required for optimal surgical cytoreduction in ovarian cancer.

Anatomy Overview

• Ligaments attaching the spleen:
  • Splenophrenic
  • Splenorenal
  • Pancreaticosplenic
  • Splenocolic
  • Gastrosplenic
• Blood supply to the spleen:
  • Splenic artery and vein come off the Celiac trunk.

Basic Steps of a Splenectomy

1. Entering the Lesser Sac:
   • Identify and transect the gastrocolic ligament.
   • Lies between the stomach's greater curvature and the transverse colon.
2. Mobilizing the spleen:
   • Dissect along the transverse colon to the splenocolic ligament.
   • Dissect upward towards the greater curvature of the stomach to the gastrosplenic ligament.
3. Ligating the vessels:
   • Identify and individually ligate splenic artery and vein.
   • Artery is ligated first to prevent spleen engorgement.

Anterior Approach

• Focus on the anterior approach in this lecture.
• Approach depends on disease distribution.

Detailed Dissection Steps

• Mobilize splenic flexure of the colon.
• Grasp and elevate the spleen medially.
• Dissect from gastrosplenic and splenophrenic ligaments.
• Gastrosplenic ligament is most vascular; contains short gastric arteries.
• Blunt dissection to locate splenic artery and vein.

Ligating the Artery and Vein

• Use right angle tool and 2-0 silk ties.
• Ligate artery first, then vein.
• Clip or tie proximal ends before dividing.

Conclusion

• Detailed process of splenectomy used in GYO surgeries.
• Important for understanding anatomy and surgical procedure.