splenectomy medical terminology
"Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. These disorders may appear in patients of any age but are most common in patients over 50. Body System: Lymphatic. Hoffman R, et al. Splenectomy. Patients are usually given protective vaccinations about a month before surgery. Control of immune reactions. MEDICAL TERM Instead of this Term / Phrase LAY TERMINOLOGY Use this Term / Phrase < Less than > Greater than Abdomen Belly, stomach National Heart, Lung and Blood Institute. The lymphatic system includes your spleen, thymus, lymph nodes and lymph channels, as well as your tonsils and adenoids. "Disorders of the Spleen." Your body's lymphatic system is part of your immune system, which protects you against infection and disease. sten(o)-"narrow in shape" or pertaining to narrowness. This surgery is called splenectomy. 1992 Oct. 47 (10):592-5. . HS can appear at any age, even in newborns, although doctors prefer to put off removing the spleen until the child is five or six years old. In blood disorders, the splenectomy will remove the cause of the blood cell destruction. Results depend on the reason for the operation. Other Words from splenectomy Example Sentences Learn More about splenectomy. See additional information . : surgical removal of the spleen. Hereditary elliptocytosis. Accessed June 11, 2018. It is not always possible, however, to predict which patients will respond well or to what degree. The most frequent serious complication following laparoscopic splenectomy is damage to the pancreas. "Application of a New Collagen-Based Sealant for the Treatment of Pancreatic Injury.". It is similar to HS in that it is characterized by red blood cells with defective membranes that are destroyed by the spleen. After the surgeon makes a cut (incision) in the abdomen, the artery to the spleen is tied to prevent blood loss and reduce the spleen's size. It contains special white blood cells that destroy bacteria and help the body fight infections when you are sick. A splenectomy is the surgical procedure that partially or completely removes the spleen. Mayo Clinic is a not-for-profit organization. Splenectomy. https://www.nhs.uk/conditions/spleen-problems-and-spleen-removal/. You will be under sedation for either procedure. It helps fight infection and filters unneeded material, such as old or damaged blood cells, from your blood.The most common reason for splenectomy is to treat a ruptured spleen, which is often caused by an abdominal injury. Medical Coding. A splenectomy is surgery to remove the entire spleen, a delicate, fist-sized organ that sits under the left rib cage near the stomach. The most important part of a medical assessment in disorders of the spleen is the measurement of splenomegaly. Accessed June 11, 2018. Accessed June 11, 2018. Definition of splenectomy. The spleen is an organ that sits under your rib cage on the upper left side of your abdomen. Then he or she closes the incisions. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Splenectomy is generally a safe procedure. See our safety precautions in response to COVID-19. During laparoscopic splenectomy, the surgeon makes four small incisions in your abdomen. The spleen is an organ that sits under your rib cage on the upper left side of your abdomen. Eur J Pediatr Surg. Laparoscopic procedures reduce the length of hospital stay, the level of post-operative pain, and the risk of infection. The spleen is a significant organ of the body’s immune system. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014. They include: Immune (idiopathic) thrombocytopenic purpura (ITP). "Impact of Concomitant Trauma in the Management of Blunt Splenic Injuries. Splenectomy (splen-ectomy) - surgical removal of the spleen. Splenectomy is the surgical removal of the spleen, which is an organ that is part of the lymphatic system. To reduce your risk of infection, your doctor may recommend vaccines against pneumonia, influenza, Haemophilus influenzae type b (Hib) and meningococci. Refer to the medical to lay terminology list below when you are preparing any research subject material. ", Bemelman, W. A., et al. A spleen that is large enough to be felt indicates splenomegaly. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Right before your surgery, you will be given a general anesthetic. "Hand-assisted Laparoscopic Splenectomy. The most common reason for splenectomy is to treat a ruptured spleen, which is often caused by an abdominal injury. The spleen is an important organ and plays an important role in immune response. Before your procedure, you may need to temporarily stop taking certain medications and supplements. Splenectomy is most commonly performed using a tiny video camera and special surgical tools (laparoscopic splenectomy). stop, stand. MedicineNet does not provide medical advice, diagnosis or treatment. Medical coding is dependent upon a solid understanding of medical terminology. Rupture sometimes occurs as a complication of pregnancy. Your surgeon watches the video images on a monitor and removes the spleen with special surgical tools that are put in the other three incisions. Cáp J. [Long-term clinical experience with spherocytic hemolytic anemia in children]. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Your doctor may recommend splenectomy if you have one of the following: Your doctor may also remove your spleen to help diagnose a condition, especially if you have an enlarged spleen and he or she can't determine why. The normal spleen cannot be felt when the doctor palpates the patient's abdomen. This site complies with the HONcode standard for trustworthy health information: verify here. Find out what is the most common shorthand of splenectomy on Abbreviations.com! There are some disorders in which splenectomy is usually recommended. The spleen is a small, solid organ, located in the upper left side of the abdomen just under the rib cage. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. After splenectomy, patients should receive oral penicillin prophylaxis (250 mg twice daily) and be instructed to seek urgent medical attention for a fever over 101º Fahrenheit. Beers, Mark H., MD, and Robert Berkow, MD., editors. Splenectomy is a surgical procedure to remove your spleen. stenography. This is a list of roots, suffixes, and prefixes used in medical terminology, their meanings, and their etymologies.Most of them are combining forms in New Latin and hence international scientific vocabulary.There are a few general rules about how they combine. dripping, trickling. Observations English-language articles published from January 1, 1990, to December 31, 2019, were retrieved from MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases. 1995 Feb. 5 (1):19-22. . spondylitis. The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the procedure. There are two diseases for which splenectomy is the only treatment—primary cancers of the spleen and a blood disorder called hereditary spherocytosis (HS). Most splenectomies are done after the patient has been diagnosed with. People without a spleen may also have a harder time recovering from an illness or injury. In some cases a surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or other complications. In the case of multiple abdominal trauma, however, the spleen is usually removed. The most important part of the assessment is the measurement of splenomegaly. If you have time before the surgery, you may need to receive blood transfusions to ensure that you have enough blood cells after your spleen is removed. He or she may also recommend that you take preventive antibiotics, especially if you have other conditions that increase your risk of serious infections. 〈http://dspace.dial.pipex.com/lrf-//〉. In some cases, the doctor may prefer conservative (nonsurgical) management of a ruptured spleen, most often when the patient's blood pressure is stable and there are no signs of other abdominal injuries. Rupture of the splenic artery. Thus far, the reported rate of overwhelming sepsis in asplenic individuals has ranged from 2.5-13.5%. Mayo Clinic facts about coronavirus disease 2019 (COVID-19), Our COVID-19 patient and visitor guidelines, plus trusted health information, Mayo Clinic Health System patient vaccination updates, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, See our safety precautions in response to COVID-19, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, Staying healthy after your spleen has been removed, FREE book offer — Mayo Clinic Health Letter, Time running out - 40% off Online Mayo Clinic Diet ends soon. Looking for the abbreviation of splenectomy? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Barbara Woodward Lips Patient Education Center. Other risks following splenectomy include inflammation of the pancreas and collapse of the lungs. In HS, the absence of a specific protein in the red blood cell membrane leads to the formation of relatively fragile cells that are easily damaged when they pass through the spleen. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. The surgery to remove your spleen is called a splenectomy. Balague, C., E. M. Targarona, G. Cerdan, et al. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Mayo Clinic does not endorse companies or products. Patients should be carefully assessed regarding the need for a splenectomy. A splenectomy may be performed as a traditional open surgery or as a laparoscopic, or minimally invasive, procedure. TTP is a rare disorder marked by. Application of a hydrogel sealant to the pancreas during surgery, however, appears to significantly reduce the risk of leakage from the pancreas. As more long-term follow-up data become available, it is likely that the true incidence will be 5-10%. ", Kahn, M. J., and K. R. McCrae. You may also need to avoid eating or drinking for a certain amount of time. All rights reserved. The storage of blood cells is called sequestration. The cell destruction does not occur elsewhere in the body and ends when the spleen is removed. Splenectomy is performed under general anesthesia. The Web's largest and most authoritative acronyms and abbreviations resource. homeostasis-staxis. ", Bjerke, H. Scott, MD, and Janet S. Bjerke, MSN. The spleen is an organ that sits right below the rib cage and exactly on the upper left side of the abdominal area. Splenectomy has been reported to improve liver fibrosis in patients with cirrhosis and hypersplenism. In some cases, splenectomy does not address the underlying causes of splenomegaly or other conditions. Older adults, especially those with cardiac or pulmonary disease, are more vulnerable to post-surgical infections. It has many functions, one of which is to help fight certain types of bacterial infections. In many cases, tissue samples will be sent to a laboratory for analysis. Schedule your appointment now for safe in-person care. ", Brigden, M.L. The most common technique is used to remove greatly enlarged spleens. Meekes I, van der Staak F, van Oostrom C. Results of splenectomy performed on a group of 91 children. ITP is a disease involving platelet destruction. This risk is highest shortly after surgery. Trauma. Suffix: The ending part of a word that modifies the meaning of the word. Root: central part of a word. Imaging studies that can be used to demonstrate splenomegaly include ultrasound tests, technetium-99m sulfur colloid imaging, and CT scans. Your lymph nodes and liver can take over many of the spleen’s important functions. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The spleen is an important part of the body's defense (immune) system. After splenectomy, notify your doctor at the first sign of an infection, such as: Make sure anyone caring for you knows that you've had your spleen removed. Your doctor may also recommend that you receive a pneumococcal vaccine and possibly other vaccines to help prevent infection after your spleen is removed. Surgeons must be aware of the rationale of vaccination in the case of splenectomy, to provide appropriate immunization in the perioperative time. Spleen problems and spleen removal. You can be active without a spleen, but you're at increased risk of becoming sick or getting serious infections. "Detection, Education and Management of the Asplenic or Hyposplenic Patient. However, the mechanisms remain unclear. The substances that are injected during this procedure include polyvinyl alcohol foam, polystyrene, and silicone. Splenectomy should be avoided in children younger than five years because of a greater risk of fulminant post-splenectomy sepsis. You should inform your Consider wearing a medical alert bracelet that indicates that you don't have a spleen. epistaxis. squamos(o)-denoting something as "full of scales" or "scaly" squama, squamous cell-stasis. Your doctor may recommend that you receive vaccines against pneumonia, influenza, Haemophilus influenzae type b (Hib) and meningococci. Start studying Splenectomy. He or she then inserts a tube with a tiny video camera into your abdomen through one of the incisions. Musallam KM, Khalife M, Sfeir PM, et al. In some cases the doctor will hear a dull sound when he or she thumps (percusses) the patient's abdomen near the ribs on the left side. "Guidelines for the Diagnosis and Management of Hereditary Spherocytosis. "Splenectomy in Immune Thrombocytopenic Purpura: Recent Controversies and Long-term Outcomes. Laparoscopic splenectomy, or removal of the spleen through several small incisions, has been more frequently used in recent years. REMOVAL OF ENLARGED SPLEEN. ), Immediately following surgery, patients should follow the physician's instructions and take all medications intended to prevent infection. In: Hematology: Basic Principles and Practice. Because of the spleen's role in protecting people against infection, it should not be removed unless necessary. If it was done to treat another disorder, additional treatment may be required. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. Laparoscopic splenectomy. Splenic embolization is an alternative to splenectomy that is used in some patients who are poor surgical risks. Correction of abnormalities of blood clotting and the number of red blood cells. REMOVAL OF RUPTURED SPLEEN. You will have heart monitor leads attached to your chest and a blood pressure cuff on your arm. When the spleen has been ruptured by trauma, the surgeon approaches the organ from its underside and fastens the splenic artery. Thromboembolism following splenectomy is another complication for this patient group, which has about 10% mortality following the surgery. The most common vaccines used are Pneumovax or Pnu-Imune 23 (against pneumococcal infections) and Menomune-A/C/Y/W-135 (against meningococcal infections). (800) 638-6833. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. Try to avoid complex medical terms and simplify the information as much as possible. Splenectomy has... Trauma. Splenectomy may be used to treat other conditions, including an enlarged spleen that is causing discomfort (splenomegaly), some blood disorders, certain cancers, infection, and noncancerous cysts or tumors. The risk of the post-splenectomy septic syndrome is lifelong and is not eliminated by the administration of polyvalent pneumococcal vaccine. Splenectomy has... Trauma. Excessive bleeding after the operation is an additional possible complication, particularly for ITP patients. Car accidents are the most common cause of blunt traumatic injury to the spleen. ", Rosen, M., R. M. Walsh, and J. R. Goldblum. Medical Author: William C. Shiel Jr., MD, FACP, FACR Sinusitis : Inflammation of the lining membrane in any of the hollow areas (sinuses) of the skull around the nose. Keep scrolling for more. ", Bolton-Maggs, P. H., R. F. Stevens, N. J. Dodd, et al. "Long-Term Outcome after Laparoscopic Splenectomy Related to Hematologic Diagnosis. ITP is a disease involving platelet destruction. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. P.O. These are relatively uncommon but have a high mortality rate. Most of these patients will be referred to a treating hematologist. If you had splenectomy due to a ruptured spleen, further treatment usually isn't necessary. Spleen removal is surgery to remove a diseased or damaged spleen. In adults, the spleen is about 4.8 × 2.8 × 1.6 in (12 × 7 × 4 cm) in size, and weighs about 4-5 oz (113-14 zg). Non-emergency Surgery Hotline. The normal spleen cannot be felt when the doctor examines the patient's abdomen. After you're unconscious, your surgeon begins the surgery using either a minimally invasive (laparoscopic) or open (traditional) procedure. Abscesses in the spleen. The spleen and its disorders. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. 43 Great Ormond Street, London, WC1N 3JJ. In patients with enlarged spleens, however, laparoscopic splenectomy is associated with less morbidity, decreased. Blood transfusions may be indicated for some patients to replace defective blood cells. This content does not have an English version. Embolization involves plugging or blocking the splenic artery to shrink the size of the spleen. Preoperative preparation for nonemergency splenectomy includes: (Illustration by Electronic Illustrators Group. (020) 7405-0101. Cesk Pediatr. The spleen is a dark-purple, bean-shaped organ located in the upper left side of the abdomen, just behind the bottom of the rib cage. On the other hand, laparoscopic splenectomy is a less invasive surgery. In open splenectomy, surgeons make a surgical incision on the left side of the abdominal cavity of the patient, remove the spleen, and close the opened incision. Pre means "before." Your doctor will give you specific instructions to help you prepare. Definition: Surgical procedure involving either partial or entire removal of the spleen. spondyl(o)-of or pertaining to the spine, the vertebra. National Health Service. Its functions include a role in the immune system; filtering foreign substances from the blood; removing worn-out blood cells from the blood; regulating blood flow to the liver; and sometimes storing blood cells. This is a list of roots, suffixes, and prefixes used in medical terminology, their meanings, and their etymology.There are a few rules when using medical roots. Sinusitis may be caused by anything that interferes with air flow into the sinuses and the drainage of mucous out of the sinuses. Box 30105, Bethesda, MD 20824-0105. Splenectomy is used to treat a wide variety of diseases and conditions. "Splenic Rupture. Firstly, prefixes and suffixes, primarily in Greek, but also in Latin, have a droppable -o-. The red blood cells are destroyed by antibodies produced by the patient's own body (autoantibodies). The spleen helps the body fight germs and infections. A ruptured spleen usually requires open splenectomy. Immune (idiopathic) thrombocytopenic purpura (ITP). Splenectomy is the surgical removal of your spleen. In some cases, he or she may also recommend preventive antibiotics, especially for children under 5 and those with other conditions that increase the risk of serious infections. Prefixes may also indicate a location, number, or time. In these cases, splenectomy is combined with a cholecystectomy. Your spleen has been removed as part of your surgical procedure. 7th ed. Wilkins, Bridget S., and Dennis H. Wright. The anesthesiologist or anesthetist gives you an anesthetic medication such as a gas — to breathe through a mask — or as a liquid injected into a vein. It also helps remove, or filter, old red blood cells from the body's circulation. They include: Immune (idiopathic) thrombocytopenic purpura (ITP). Section 11, Chapter 141 In. Schrier SL. ", Lo, A., A. M. Matheson, and D. Adams. Laparoscopic surgery involves the use of surgical instruments, with the assistance of a tiny camera and video monitor. This is a relatively rare disorder. Splenectomies are performed for a variety of different reasons and with different degrees of urgency. Medical terminology is composed of a prefix, root word, and suffix: Prefix: A prefix is placed at the beginning of a word to modify or change its meaning. Splenectomy is a medical procedure that involves the removal of a patient’s spleen. In some cases the surgeon removes only part of the spleen. They include: In other disorders, the spleen may or may not be removed. In healthy adults, about 30% of blood platelets are sequestered in the spleen. (301) 251-1222. Blood 2004; 104:2623. splenectomy. home / medterms medical dictionary a-z list / splenectomy definition It also helps prevent further sequestration of blood cells. Splenectomy Lifelong precautions What is a splenectomy? But as with any surgery, splenectomy carries the potential risk of complications, including: After spleen removal, you're more likely to contract serious or life-threatening infections. After splenectomy, other organs in your body take over most of the functions previously performed by your spleen. Splenectomy: Spleen removal. It helps fight infection and filters unneeded material, such as old or damaged blood cells, from your blood. Tonsillectomy (tonsill-ectomy) - surgical removal of the tonsils, typically due to tonsillitis. steth(o)- Splenectomy for hematologic disorders such as idiopathic thrombocytopenia (ITP) is a result of failed medical management to control thrombocytopenia or abdominal pain associated with splenomegaly. Splenectomy is indicated for severe ITP with acute life-threatening bleeding that is non-responsive to medical treatment or in patients with chronic ITP with bleeding and/or limitation of a patient’s activities, for example, contact sports (because of potential danger of ICH), and non-responsive to medical treatment. … Autoimmune hemolytic disorders. More recently, however, the introduction of new drugs in the treatment of ITP has reopened the question as to whether splenectomy is always the best treatment option. Approach to the adult with splenomegaly and other splenic disorders. Car accidents are... Abscesses in the spleen. The most important part of aftercare, however, is long-term caution regarding vulnerability to infection. First, prefixes and suffixes, most of which are derived from ancient Greek or classical Latin, have a droppable -o-. Patients should see their doctor at once if they have a fever or any other sign of infection, and avoid travel to areas where exposure to, The chief risk following splenectomy is overwhelming bacterial infection, or postsplenectomy. Make a donation. The rate of platelet or red blood cell destruction by the spleen can be measured by tagging blood cells with radioactive chromium or platelets with radioactive indium. Start studying Medical Terminology Chapter 9. Advertising revenue supports our not-for-profit mission. Yet without your spleen, you will be … Splenectomy has been regarded as the definitive treatment for this disease and is effective in about 70% of chronic ITP cases. Thrombotic thrombocytopenic purpura (TTP). Infection immediately following surgery may also occur. The operation is relatively safe for young and middle-aged adults. splenectomy: Prefix: Prefix Definition: 1st Root Word: splen/o 1st Root Definition: spleen 2nd Root Word: 2nd Root Word Definition: Suffix: -ectomy Suffix Definition: removal; excision; resection Definition: surgical removal; excision; resection of the spleen: spondylitis: Prefix: Prefix Definition: 1st Root Word: spondyl/o This content does not have an Arabic version. Normal results for patients with an enlarged spleen are relief of pain and of the complications of splenomegaly. Car accidents are... Abscesses in the spleen. Leukaemia Research Fund. The larger the spleen, the more likely your surgeon will choose to do an open splenectomy. Splenectomy is a surgical procedure to remove your spleen. Injury to nearby organs, including your stomach, pancreas and colon, Redness or tender spots anywhere on the body. The method used often depends on the size of the spleen. https://www.uptodate.com/contents/search. A splenectomy is a surgical procedure to remove the whole spleen, a sensitive, fist-sized organ that sits underneath the left rib cage close to the stomach. It contains unique white blood cells (WBC) that annihilate bacteria and help the body fight infections when you are debilitated. Topectomy (top-ectomy) - surgery performed to remove part of the cerebral cortex of the brain for the treatment of certain psychiatric disorders and some types of epilepsy. You spleen may be removed due to certain cancers, blood disorders, trauma, infection, an inherited disease or because it’s overactive and enlarged. The spleen is in the upper part of the belly, on the left side underneath the ribcage. Splenectomies are performed in children only when the benefits outweigh the risks. Embolization is a technique that needs further study and refinement. With this type of surgery, you may be able to leave the hospital the same day and recover fully in two weeks. Some doctors also recommend a two-year course of penicillin following splenectomy, or long-term treatment with ampicillin. In our case, normal vaginal delivery was conducted after induction of labour, followed by a referral to general surgery for, Radiodiagnostic imaging is imperative for faster diagnosis and treatment with percutaneous drainage to defer impending rupture and need for surgical, Accessory spleens can have compensatory hypertrophy of residual splenic tissue following, Lower than the median of 15 (range 4-46) in operations with associated, There is controversy within the literature as to proper management as laparoscopic, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, Evans Syndrome and pregnancy: A case report with literature review, Analysis of the surgical treatment of the patients operated on by using laparoscopic and classic splenectomy due to benign disorders of the spleen, Adverse factors responsible for below-normal platelet count after laparoscopic splenectomy and azygoportal disconnection, Splenic abscess: Conservative management in children, Isolated Splenic Cold Abscesses in an Immunocompetent Individual, Accessory Spleen Presenting as a Submucosal Lesion on Stomach Wall after Splenectomy, DISTAL PANCREATECTOMY IN THE SURGICAL TREATMENT OF PANCREATIC CANCER--A STUDY, DELAYED SPLENIC RUPTURE IN MASSIVE SPLENOMEGALY--A CASE REPORT/ODLOZENA RUPTURA SLEZINE KOD MASIVNE SPLENOMEGALIJE--PRIKAZ SLUCAJA, Challenges and Results of Laparoscopic Splenectomy for Hematological Diseases in a Developing Country, Fatal Pneumococcus Sepsis after Treatment of Late Antibody-Mediated Kidney Graft Rejection, Laparoscopic Splenectomy for Splenic Metastasis from Primary Lung Carcinoma, Splenectomy and Gastroesophageal Decongestion. The surgeon detaches the ligaments holding the spleen in place and removes it. A single copy of these materials may be reprinted for noncommercial personal use only. To be successful and accurate medical coders must have a solid understanding of common medical terms for various reasons which include: Reading and understanding medical dictation Proper code look up … This procedure is considered by some to be a useful compromise that reduces pain from an enlarged spleen while leaving the patient less vulnerable to infection. ITP is a disease involving platelet destruction. https://medical-dictionary.thefreedictionary.com/splenectomy. Long-term follow-up of the results of partial splenectomies has not yet been done. They also leave smaller, Laparoscopic splenectomy is gaining increased acceptance in the early 2000s as an alternative to open splenectomy for a wide variety of disorders, although splenomegaly still presents an obstacle to laparoscopic splenectomy; massive splenomegaly has been considered a contraindication. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Laparoscopic splenectomy isn't appropriate for everyone.