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Zhang R, Yan C, Kang C, Chen B, Guo C. Hand-Assisted Laparoscopic Splenectomy with Temporary Splenic Artery Occlusion in Pediatric Patients: The Experience in a Chinese Tertiary Children's Hospital. J Laparoendosc Adv Surg Tech A 2022; 32:1016-1021. [PMID: 35617701 DOI: 10.1089/lap.2021.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The hand-assisted laparoscopic splenectomy (HALS) approach overcomes the difficulties experienced with conventional laparoscopic splenectomy (LS) with added advantages. In this study, we compared the HALS technique with standard LS based on the feasibility and intermediate postoperative outcomes in pediatric patients. Methods: We retrospectively investigated pediatric patients who underwent HALS or LS from October 2013 to May 2021 at the Children's Hospital, Chongqing Medical University. Potential parameters related to HALS or LS were explored, and the intermediate-term clinical outcomes were compared between the two groups. The quality of life and splenic regrowth data were followed up routinely for 12 months after the operation. Results: In total, 39 patients underwent splenectomy (11 for HALS and 28 for LS) and were eligible for this research. Patients who underwent HALS had a greater proportion of focal benign splenic lesions (P < .001) and partial splenectomy (P < .001). The HALS operative time was reduced compared with LS (P = .032). No operation conversion was noted in the HALS group, whereas 4 (14.3%) cases were converted to an open operation (P = .249). For partial splenectomies, favorable outcomes with HALS, including short operative time (P = .001) and reduced blood loss (P = .014), were noted compared with LS. No postoperative mortality was observed. During the follow-up period, a good quality of life and splenic regrowth were noted for most of the patients. Conclusions: Although another incision is necessary, HALS confers the advantages of a minimally invasive technique to manage the fragile spleen, especially in pediatric patients requiring partial splenectomy.
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Affiliation(s)
- Rensen Zhang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Cailong Kang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Bailin Chen
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Chunbao Guo
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
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Huang Y, Wang XY, Wang K. Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A meta-analysis. World J Clin Cases 2019; 7:320-334. [PMID: 30746373 PMCID: PMC6369387 DOI: 10.12998/wjcc.v7.i3.320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hand-assisted laparoscopic splenectomy (HALS) can help overcome the drawbacks of laparoscopic splenectomy (LS) while maintaining its advantages.
AIM To evaluate the efficacy and advantages of HALS for splenomegaly.
METHODS The relevant literature was reviewed using the PubMed, EMBASE, Cochrane, Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from 16 trials who met the inclusion criteria were selected.
RESULTS In pure splenectomy, blood loss volume (P < 0.001) and conversion rate (P = 0.008) were significantly lower in the HALS group than in the LS group. Conversely, for splenomegaly, the operative time (P = 0.04) was shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach (DUS), the operative time (P = 0.04) was significantly shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.
CONCLUSION HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.
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Affiliation(s)
- Yong Huang
- Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Yun Wang
- Department of Operating Room, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Kai Wang
- Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Nishikawa T, Takahashi M, Mori M, Kamikawa Y, Inoue F. Solitary splenic metastasis of pulmonary carcinoid: A rare case report and literature review. Mol Clin Oncol 2017; 7:163-166. [PMID: 28781779 PMCID: PMC5532704 DOI: 10.3892/mco.2017.1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 05/10/2017] [Indexed: 11/15/2022] Open
Abstract
We herein report a rare case of solitary splenic metastasis of a pulmonary carcinoid, for which hand-assisted laparoscopic splenectomy was performed. A 73-year-old man was admitted to the Inoue Hospital (Fukuyama, Japan) in March 2015 with an abnormal shadow of the spleen. The patient had a history of right upper lobectomy with lymph node dissection for a pulmonary typical carcinoid (pT1N0M0 stage IA) 7 years earlier. Plain abdominal computed tomography (CT) revealed a low-density area in the spleen. Enhanced abdominal CT revealed a mass in the spleen measuring 3×3 cm. Blood tests and tumor marker analysis revealed no abnormalities. Abdominal magnetic resonance imaging revealed a mass that was low-intensity on T1- and high-intensity on T2-weighted images, and positron emission tomography revealed abnormal fluorodeoxyglucose accumulation in the mass. Hand-assisted laparoscopic splenectomy was performed for diagnosis and treatment. The resected specimen included a reddish-brown mass. On immunohistochemistry, the mass was positive for chromogranin A, synaptophysin and CD56, which was similar to the resected pulmonary carcinoid tumor; thus, splenic metastasis of pulmonary carcinoid was diagnosed. The postoperative course was uneventful and the patient is currently under observation and remains recurrence-free, with no adjuvant chemotherapy.
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Affiliation(s)
- Toshio Nishikawa
- Department of Thoracic Surgery, Inoue Hospital, Fukuyama, Hiroshima 721-0974, Japan
| | - Masahiko Takahashi
- Department of Thoracic Surgery, Inoue Hospital, Fukuyama, Hiroshima 721-0974, Japan
| | - Masanobu Mori
- Department of Thoracic Surgery, Inoue Hospital, Fukuyama, Hiroshima 721-0974, Japan
| | - Yasuaki Kamikawa
- Department of Thoracic Surgery, Inoue Hospital, Fukuyama, Hiroshima 721-0974, Japan
| | - Fumiyuki Inoue
- Department of Thoracic Surgery, Inoue Hospital, Fukuyama, Hiroshima 721-0974, Japan
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Gong JQ, Cao YK, Wang YH, Zhang GH, Wang PH, Luo GD. Three-step hand-assisted laparoscopic surgery for radical distal gastrectomy: an effective surgical approach. Int J Clin Exp Med 2014; 7:2156-2164. [PMID: 25232401 PMCID: PMC4161561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/27/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical technique based on hand-assisted laparoscopic surgery (HALS) for the treatment of gastric cancer. This surgical approach is particularly easy and convenient for radical distal gastrectomy. In order to thoroughly understand the advantages of applying "three-step HALG" in distal gastrectomy, our center conducted a retrospective study to analyze data from patients who underwent HALG and laparoscopic-assisted D2 radical gastrectomy (LAG) during the corresponding time period. METHODS The HALG procedure is performed in three steps, namely the operation performed through an auxiliary incision under direct vision, hand-assisted laparoscopic operation, and gastrointestinal tract reconstruction through the auxiliary incision under direct vision. This study performed comprehensive, in-depth comparative analyses on the clinical data of two groups of patients who underwent HALG and LAG. RESULTS The auxiliary incision under the xiphoid was maximally utilized in the HALG procedure. The rate of conversion to open surgery in HALG group patients was significantly lower than in the LAG group (P = 0.03), and the operating time was significantly shorter in the HALG group than in the LAG group (P = 0.00). There was no significant difference in the pain rate score on postoperative day 2 and on the day of discharge between the HALG and LAG groups (P > 0.05). No statistically significant difference was found in the time to recovery of bowel function, postoperative hospital stay, or postoperative complications (P > 0.05), although the values were all lower in the HALG group than in the LAG group. CONCLUSION "Three-step HALG" is a highly feasible surgical approach for radical distal gastrectomy.
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Qian D, He Z, Hua J, Gong J, Lin S, Song Z. Hand-assisted versus conventional laparoscopic splenectomy: a systematic review and meta-analysis. ANZ J Surg 2014; 84:915-20. [PMID: 24712437 DOI: 10.1111/ans.12597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hand-assisted laparoscopic splenectomy (HALS) has been widely applied for the resection of larger spleens. We conducted a systematic review and meta-analysis to evaluate the safety and feasibility of HALS compared with conventional laparoscopic splenectomy (CLS). METHODS A comprehensive literature search in MEDLINE, EMBASE and Cochrane Library databases was performed to compare clinical outcomes of CLS and HALS. Data were extracted by two independent reviewers. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated by meta-analytic software. RESULTS Nine non-randomized controlled studies for a total of 463 patients were selected to satisfy the inclusion criteria (HALS versus CLS: 170 versus 293, respectively). The groups were similar in operative time, estimated operative blood loss, length of hospital stay, mortality and intraoperative and post-operative complications. There was a significantly reduced conversion rate in the HALS versus CLS group (odds ratio: 2.98; 95% confidence interval 1.28 to 6.93; P = 0.01). Splenic weights in the HALS group were higher than in the CLS group (weighted mean differences: -0.93; 95% confidence interval -1.74 to -0.11; P = 0.03). CONCLUSION HALS may be preferable to CLS for the treatment of patients with enlarged spleens. The result needs to be certified by further random controlled trials.
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Affiliation(s)
- Daohai Qian
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
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Wang X, Li Y, Peng B. Hand-assisted laparoscopic technique in the setting of complicated splenectomy: a 9-year experience. World J Surg 2013; 37:2046-52. [PMID: 23756773 DOI: 10.1007/s00268-013-2114-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is significantly more challenging in patients with supramassive splenomegaly and those with portal hypertension. We hypothesized that hand-assisted laparoscopic splenectomy (HALS) could facilitate the procedure in these patients. METHODS Before October 2009, patients with supramassive splenomegaly and those with portal hypertension underwent LS. After October 2009, we routinely applied HALS in patients with these disorders. RESULTS We compared the HALS group (n = 41) with the LS group (n = 45). There were no conversions to open surgery in the HALS group, whereas there was an 4.5 % conversion rate in the LS group. The operating times were shorter, and there was less estimated blood loss, and fewer major complications in the HALS group. Analgesia requirement, time to full diet, and postoperative stay were comparable in the two groups. CONCLUSIONS We concluded that HALS was superior to LS in patients with supramassive splenomegaly and in those with portal hypertension.
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Affiliation(s)
- Xin Wang
- Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Khamechian T, Alizargar J, Farzanegan M. Pattern of splenectomy indications in kashan shahid-beheshti hospital: a 5-year study. ARCHIVES OF TRAUMA RESEARCH 2013; 1:180-3. [PMID: 24396775 PMCID: PMC3876498 DOI: 10.5812/atr.8258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 10/27/2012] [Accepted: 11/01/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND The spleen is amongst the most vulnerable organs which are easily injured in abdominal trauma. Nowadays, blunt trauma is the most prevalent indication of splenectomy. OBJECTIVES We conducted this study to determine the pattern of indications for open splenectomies carried out during the past five years in Shahid-Beheshti hospital, a central hospital in Kashan, Iran. PATIENTS AND METHODS Demographic data of all patients who had undergone an open splenectomy in Kashan Shahid-Beheshti hospital during the past five years (2007-2012), indications for this type of surgery and outcome of patients were collected and entered into the study. RESULTS During the study period, the data from a total of 99 open splenectomies were entered in our study. Sixty-eight (68.7%) patients were male and 31 (31.1%) female. The mean age was 31.64 years, 75.8% of the cases had indications of trauma and 24.2% were elective. The most prevalent indication for trauma was motor-bike rider accidents and for elective ones portal hypertension. CONCLUSIONS Most cases of splenectomy in our center caused by trauma, and among the different types of trauma, blunt trauma is the dominant cause. Road traffic accidents, in particular motor vehicle accidents, especially motorbike injures, are the most frequent cause of splenectomy. Due to the instability of trauma patients, a mortality rate of 8% seems to be reasonable for splenectomy. We recommend that more research be conducted in this area and more cases enrolled with a reasonable follow-up period for splenectomy complications in this study.
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Affiliation(s)
- Tahere Khamechian
- Department of Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Tahere Khamechian, Department of Anatomical Sciences Research Center, Kashan University of Medical Sciences, 5th Km-Qotb-e Ravandi Blv. P.O. Box: 87155.111, Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615579028, E-mail:
| | - Javad Alizargar
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Maryam Farzanegan
- Department of Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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