Hand-assisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly
Archives of Surgery
Hypothesis: Laparoscopic splenectomy (LS) is the procedure of choice for elective splenectomy. Splenomegaly may preclude safe mobilization and hilar control using conventional laparoscopic techniques. Hand-assisted LS (HALS) may offer the same benefits of minimally invasive surgery for splenomegaly while allowing safe manipulation and splenic dissection. Design: A retrospective review of patients with splenomegaly undergoing conventional LS or HALS was performed. Setting: Tertiary care referral center. Patients: Hand-assisted LS was performed at the start of the operation for patients with splenomegaly; splenomegaly was determined by palpation of the splenic tip extending to the midline or the iliac crest, or by a craniocaudal splenic length of greater than 22 cm. Splenomegaly was defined as a splenic weight of greater than 700 g after morcellation. Main Outcome Measures: Patient demographic characteristics, operative indications, splenic weight after morcellation, morbidity, mortality, and clinical outcomes were evaluated. Results: Forty-five patients with splenomegaly were identified: 31 underwent standard LS and 14 underwent HALS. The HALS group had significantly larger spleens than the conventional LS group (mean weight, 1516 vs 1031 g; P=.02). Mean operative time (177 vs 186 minutes; P=.89), estimated blood loss (602 vs 376 mL; P=.17), and length of hospital stay (5.4 vs 4.2 days; P=.24) and complication rates (5 [36%] of 14 vs 5 [16%] of 31; P=.70) were similar between the HALS and the standard LS groups. No perioperative mortality occurred. Conclusions: Hand-assisted LS is a safe and efficacious procedure for these extremely difficult cases. Hand-assisted LS provides the benefits of a minimally invasive approach in cases of splenomegaly.
Rosen, M., Brody, F., Walsh, R., & Ponsky, J. (2002). Hand-assisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly. Archives of Surgery, 137 (12). http://dx.doi.org/10.1001/archsurg.137.12.1348