I welcome this work with enthusiasm. Having devoted most of my professional life to study the spleen and to research on techniques of splenic resection, I was pleased and honored when the editor of this book, Dr. Andy Petroianu, asked me to write a Forward to it. Books solely on the spleen are relatively rare and books on splenic surgery are even rarer. Among human solid organs, the spleen seems to be an orphan. With most other organs, such as the brain, heart, and kidney, much has been written on their history, anatomy, function and surgical treatment. An up-to-date volume on the current concepts and techniques of splenic surgery is the most necessary and commendable addition.
Why has the spleen lagged behind other organs in published works? In the popular mind, many people are unaware that they even have a spleen. Still others do not know where in the body it is located. Almost no one knows what it does. For surgeons, it has long been a bête noir, accessible only with difficulty high in the left upper quadrant and so fragile that even minor inadvertent injury could lead to lethal hemorrhage. That this is no longer true which is amply written about in this book by a group of international experts in splenic disease and splenic surgery.
Modern splenic surgery owes its spectacular rise partially to advances in other fields. In the diagnosis of splenic diseases, the explosive growth of imaging capabilities has been added immensely to our capabilities. These have included radionuclide scanning, ultrasound, computerized tomography and magnetic resonance imaging. They all contributed to elucidating difficult diagnostic problems. New hemostatic techniques can also be credited, since the spleen is so unforgivably fragile and subject to obstinate and dangerous bleeding. For this problem, there were advances such as electro cautery, stapling, argon beam, high frequency ultrasound and a great variety of topical hemostatic agents such as fibrin glue, microfibrillar collagen and a host of others. Finally, the laparoscopic revolution has been truly transformative. Frankly, when it was first mentioned to me, I was incredulous as I recalled my many years of struggle in the left upper quadrant with the abdomen open. To think that all of that could be accomplished remotely through a narrow tube was beyond my imagination. I was proven wrong in my own institution when bold surgeons looked past my doubts and were among the first to perform and publish on laparoscopic splenectomy. It has now become the standard of care for many splenic diseases.
What is there to look forward to some future edition of this book on the same subject material? Predictions are always dangerous but are good mental exercises and sometimes come true. I think that a number of diseases now requiring splenectomy will be eliminated by advances in genomic medicine, targeted chemotherapy and stem cell therapy and other new approaches. Splenectomy in the leukemias will become increasingly rare or non-existent. Witness, for example, the success of Gleevec for myelogenous leukemia and the purine analogues for hairy cell leukaemia. Splenectomy for metabolic diseases like Gaucher Disease will also become rarer. Witness the success of the replacement enzyme, glucocerebrocidase. Splenectomy for parasitic diseases will yield to specific therapies as they are discovered. Splenectomy for a malignant neoplasm such as Hodgkin’s Lymphoma has virtually disappeared and other tumors will also be conquered as the cure or cures for cancer are found. Splenectomy for benign neoplasms such as hemangioma will yield to better diagnosis and conservative surgery.
I also believe that the technique of laparoscopic splenectomy will be enhanced by three dimensional imaging, zoom capabilities and texture detecting technology. There will also be new hemostatic manoeuvres and topical agents that will ease the bleeding problem. Finally, I am convinced that conservative surgery of the spleen will become the standard of care world-wide, it is an organ that is much better left in than taken out.
This book serves the purpose of a comprehensive survey and description of the current state of the art of splenic surgery. It is timely, necessary and indeed welcome.
Leon Morgenstern
UCLA School of Medicine,
Califórnia
USA
