Laparoscopic radiofrequency ablation for traumatic splenic rupture

Background: Laparotomy was formerly the routine approach for treating traumatic splenic rupture. Traumatic splenic rupture has traditionally been treated with open splenectomy. The advent of laparoscopy and radiofrequency ablation (RFA) has ushered in new approaches to this surgical problem. The purpose of this study was to evaluate the use of laparoscopic RFA to treat traumatic splenic rupture. Methods: Four patients with traumatic splenic ruptures underwent laparoscopic RFA-assisted spleen-preserving surgery between September 2011 and April 2012. RFA electrodes were used for traumatic rupture repair or partial splenectomies using classic laparoscopic procedures. Safety and efficacy parameters were documented, including surgery time, intraoperative blood loss, postoperative drainage quantities, and recovery conditions. Results: Three patients received laparoscopic splenic rupture repair and one patient received a partial splenectomy. Three surgeries were successful, based on 1-mo follow-up with computerized tomography and ultrasound examinations that indicated the restoration of satisfactory splenic blood supply. The fourth patient received a laparotomy for a total splenectomy because of massive postoperative bleeding 24 h after surgery. Conclusions: Laparoscopic RFA-assisted spleen-preserving surgery is another modality that may be considered in the management of splenic trauma. This small sample size and limited clinical experience does not justify its use on a routine basis and requires additional clinical research to fully evaluate its efficacy in certain critical traumatic scenarios compared with traditional open splenectomy. (C) 2013 Elsevier Inc. All rights reserved.