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Huang L, Yu Q, Peng H, Zhen Z. LigaSure technique for splenectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34719. [PMID: 37657000 PMCID: PMC10476714 DOI: 10.1097/md.0000000000034719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND This study aimed to clarify the optimal management of the LigaSure technique and conventional techniques during splenectomy. METHODS All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed, and Cochrane databases up to April 2023, were searched for relevant studies comparing the LigaSure technique with conventional techniques. Six studies, extracted by 2 independent reviewers, were evaluated for blood loss, operative time, conversion, mortality, hospital stay, and transfusion. RESULTS The blood loss was significantly higher in the convention group than in the LigaSure group (WMD = -48.98, 95% CI: -62.41 to -35.55, P < .00001). Meanwhile, the mean operative time was significantly shorter in LigaSure group than in convention group (WMD = -10.57; 95% CI: -12.35 to -8.78), P < .00001). No significant differences were found regarding the conversion rate, hospital stay, morbidity, and transfusion. CONCLUSIONS The LigaSure technique has comparable effects to conventional techniques, but to some extent reduces blood loss and operative time.
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Affiliation(s)
- Long Huang
- Department of No.1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Qingsheng Yu
- Department of No.1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Hui Peng
- Department of No.1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Zhou Zhen
- Department of Surgery, The Second Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
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Fathi A, Elmoatasembellah M, Senbel A, Shahatto F, Eldamshety O, Shetiwy M, Abdel Wahab K, Abouzid A, Setit A. Safety and Efficacy of Using Staplers and Vessel Sealing Devices for Laparoscopic Splenectomy: A Randomized Controlled Trial. Surg Innov 2020; 28:303-308. [PMID: 32845223 DOI: 10.1177/1553350620953023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background. Laparoscopic splenectomy (LS) is considered the operation of choice on elective basis for managing patients with certain hematological disorders. Hemostatic control of the splenic pedicle is one of the crucial steps in LS. This study compares the safety and efficacy of using endoscopic staplers and vessel sealing devices to control the splenic pedicle in patients with nonsevere splenomegaly. Methods. Fifty-one consecutive patients with different blood disorders including idiopathic thrombocytopenic purpura (ITP), hypersplenism, and lymphoma were randomized for elective LS. Traditional steps of LS, via lateral approach, were followed, and pedicle control was done with either endovascular gastrointestinal anastomosis stapler (n = 26) or vessel sealing device (Ligasure) (n = 25). Results. No difference was noted with different splenic spans when using either methods of pedicle control (P = .145). The volume of blood loss was higher in the Ligasure group compared to the staplers group (182 mL vs 131 mL, respectively), but was not statistically significant (P = .249). Conversion to open was notably higher in the Ligasure group (P = .034), but the intraoperative complications were comparable in both groups (P = .357). Conclusion. The use of vessel sealing devices for splenic pedicle control has comparable surgical outcomes compared with the use of endoscopic staplers for LS, but with higher rate of conversion to open surgery.
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Affiliation(s)
- Adel Fathi
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Mansour Elmoatasembellah
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Ahmed Senbel
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Fayez Shahatto
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Osama Eldamshety
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Mosab Shetiwy
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Khaled Abdel Wahab
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Amr Abouzid
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Ahmed Setit
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
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Schizas D, Katsaros I, Karatza E, Kykalos S, Spartalis E, Tsourouflis G, Dimitroulis D, Nikiteas N. Concomitant Laparoscopic Splenectomy and Cholecystectomy: A Systematic Review of the Literature. J Laparoendosc Adv Surg Tech A 2020; 30:730-736. [PMID: 32202962 DOI: 10.1089/lap.2020.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Concomitant laparoscopic splenectomy and cholecystectomy (CLSC) is performed for concurrent pathologies of the spleen and gallbladder. This systematic review aimed to evaluate the available evidence on its indications, operative technique, and outcomes. Materials and Methods: The PubMed and Cochrane bibliographical databases were searched from the beginning of time (last search: December 6, 2019) for studies reporting on CLSC. The National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool was utilized for the evaluation of eligible articles. Results: Eight studies met inclusion criteria and concerned collectively 108 patients (53 males and 55 females) with a mean age of 27.02 ± 20.48 years (mean, SD). The most common surgery indications were hereditary spherocytosis (38.9%) and sickle cell disease or β-thalassemia (32.4%). Laparoscopic cholecystectomy preceded splenectomy in the majority of cases (75%). A five-trocar approach was most frequently (89.8%) utilized. The mean operation duration was 170.18 ± 53.07 minutes (mean, SD). Resected spleen weight was 601.82 ± 386.02 g (mean, SD) and had a length of 18.74 ± 5.3 cm (mean, SD). The conversion rate was 2.7%, while 20.4% of included cases experienced postoperative complications. Most frequent ones included pulmonary infection (6.5%) and portal/splenic vein thrombosis (4.6%). No postoperative death was recorded. Mean hospitalization period was 5.43 ± 3.18 days (mean, SD). Conclusions: CLSC is a safe and feasible operation for simultaneous diseases of the spleen and gallbladder that require elective procedures. High-quality clinical trials are essential to further elucidate clinical evidence and standardize operative technique.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery and National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery and National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Elli Karatza
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stylianos Kykalos
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Eleftherios Spartalis
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Gerasimos Tsourouflis
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Nikiteas
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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A Systematic Review and Meta-Analysis of Anterior Versus Lateral Approach for Laparoscopic Splenectomy. Surg Laparosc Endosc Percutan Tech 2019; 29:233-241. [DOI: 10.1097/sle.0000000000000627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Pelizzo G, Guazzotti M, Klersy C, Nakib G, Costanzo F, Andreatta E, Bassotti G, Calcaterra V. Spleen size evaluation in children: Time to define splenomegaly for pediatric surgeons and pediatricians. PLoS One 2018; 13:e0202741. [PMID: 30138410 PMCID: PMC6107197 DOI: 10.1371/journal.pone.0202741] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 08/08/2018] [Indexed: 01/14/2023] Open
Abstract
Background We determined the range of normal spleen dimensions evaluated by ultrasonography (US) in children according to sex and age and the relationship between splenic measurements, auxological data and body proportions, in order to define splenomegaly parameters in support of the surgical mini-invasive approaches in pediatrics. Methods We prospectively examined 317 caucasian children of both sexes. The patients were divided into three groups: 0–3 years; 4–10 years; 11–18 years. Sex, weight, height/length, body mass index (BMI), waist circumference and xipho-pubic distance were determined for each child. US spleen evaluation included longitudinal/antero-posterior/transverse diameters, transverse area and volume. Spleen volume/abdominal volume, longitudinal spleen diameter/longitudinal left kidney diameter and longitudinal spleen diameter/xipho-pubic distance ratios were also calculated. Results For caucasian subjects, in different age groups spleen volume, transverse area and diameter increased while the spleen/abdominal volume ratio decreased significantly (p<0.001). A significant (p<0.001) decrease in longitudinal spleen diameter/xipho-pubic distance ratio was noted between the 0–3 years group and both 4–10 and 11–18 years group. Age and auxological data, except BMI, showed a high correlation with spleen dimension (r≥0.8). Conclusions The current concept of splenomegaly is not applicable in pediatric surgery. A dedicated classification of splenomegaly is needed for children and would improve the safety and feasibility of treatment.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Unit, Children's Hospital, Istituto Mediterraneo di Eccellenza Pediatrica, Palermo, Italy
| | - Marinella Guazzotti
- Pediatric Surgery Unit, Department of the Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ghassan Nakib
- Department of Paediatric Surgery, Medclinic Middle East, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Federico Costanzo
- Pediatric Surgery Unit, Department of the Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erika Andreatta
- Pediatric Surgery Unit, Department of the Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabrio Bassotti
- Gastroenterology Section, Department of Medicine, University of Perugia Medical School, Perugia, Italy
| | - Valeria Calcaterra
- Pediatric Unit, Department of the Mother and Child Health Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine University of Pavia, Pavia, Italy
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Salama HF, Khirallah MG, Elsawaf MI, ELafify MA. Bipolar sealing devices versus endoscopic vascular staplers during laparoscopic splenectomy in children with benign hematological diseases. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000525978.63934.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Misiakos EP, Bagias G, Liakakos T, Machairas A. Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc 2017; 9:428-437. [PMID: 28979707 PMCID: PMC5605342 DOI: 10.4253/wjge.v9.i9.428] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/21/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes.
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Affiliation(s)
- Evangelos P Misiakos
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
| | - George Bagias
- Clinic for General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasios Machairas
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
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Lateral Versus Anterior Approach Laparoscopic Splenectomy: A Randomized-controlled Study. Surg Laparosc Endosc Percutan Tech 2016; 26:465-469. [DOI: 10.1097/sle.0000000000000339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kawanaka H, Akahoshi T, Kinjo N, Harimoto N, Itoh S, Tsutsumi N, Matsumoto Y, Yoshizumi T, Shirabe K, Maehara Y. Laparoscopic Splenectomy with Technical Standardization and Selection Criteria for Standard or Hand-Assisted Approach in 390 Patients with Liver Cirrhosis and Portal Hypertension. J Am Coll Surg 2015. [PMID: 26206637 DOI: 10.1016/j.jamcollsurg.2015.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is still challenging in patients with liver cirrhosis and portal hypertension. This study was designed to establish safe and less invasive LS in patients with liver cirrhosis and portal hypertension. STUDY DESIGN We analyzed 390 patients with liver cirrhosis and portal hypertension, who underwent LS between 1993 and 2013. Patients were divided into 3 time periods; early (1993 to 2004, n = 106); middle (2005 to 2008, n = 159); and late (2008 to 2013, n = 125). During the middle time period, standardized technique for LS and selection criteria for hand-assisted LS were adopted. Patients with spleen volume ≥ 1,000 mL by CT volumetry, large perisplenic collateral vessels, and/or Child-Pugh score ≥ 9, underwent hand-assisted LS. During the late time period, the selection criteria were refined and patients with spleen volume ≥ 600 mL underwent hand-assisted LS. RESULTS Conversion to open splenectomy decreased (10.4% in the early time period, 1.9% in the middle time period, and 3.2% in the late time period, p = 0.004), median blood loss decreased (300g, 87g, and 98g, respectively, p < 0.001), and the success rate of pure LS tended to improve (87.2%, 89.5%, and 98.0%, respectively, p = 0.110). Mortality was 0% in each time period, Clavien-Dindo grade IIIb or more complications tended to decrease (5.7%, 2.5%, and 0.8%, respectively, p = 0.081), and technique-related complications decreased significantly (10.4%, 3.8%, and 2.4%, respectively, p = 0.014). CONCLUSIONS Laparoscopic splenectomy is now a safe and less invasive approach, even in patients with liver cirrhosis and portal hypertension, because of its technical standardization with the refined selection criteria for pure or hand-assisted LS.
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Affiliation(s)
- Hirofumi Kawanaka
- Department of Surgery and Multidisciplinary Treatment, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Clinical Research Institute, National Hospital Organization, Beppu Medical Center, Beppu, Japan.
| | - Tomohiko Akahoshi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nao Kinjo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Norifumi Harimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Norifumi Tsutsumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Multidisciplinary Treatment, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Giza DE, Tudor S, Purnichescu-Purtan RR, Vasilescu C. Robotic Splenectomy: What is the Real Benefit? World J Surg 2014; 38:3067-73. [DOI: 10.1007/s00268-014-2697-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Cai Y, Liu X, Peng B. A Novel Method for Laparoscopic Splenectomy in the Setting of Hypersplenism Secondary to Liver Cirrhosis: Ten Years’ Experience. World J Surg 2014; 38:2934-9. [DOI: 10.1007/s00268-014-2652-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Podevin G, Victor A, De Napoli S, Heloury Y, Leclair MD. Laparoscopic splenectomy: comparison between anterior and lateral approaches. J Laparoendosc Adv Surg Tech A 2011; 21:865-8. [PMID: 21854204 DOI: 10.1089/lap.2011.0108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM Splenectomy, except for a traumatic purpose, is now performed through a laparoscopic approach. There are mainly two ways for laparoscopic total or partial splenectomies. For the classic anterior dissection of the splenic vessels, patient is placed in supine position and five ports are required to elevate the spleen and proceed to vessel divisions. With a lateral approach of the pedicle, patient is placed in lateral decubitus position and three ports are sufficient, because gravity help to provide traction on the splenic ligaments and to present hilar vessels and pancreas tail. The aim of our study was to compare surgical complications of those two approaches of laparoscopic splenectomy in children. METHODS We reviewed 84 medical records of patient operated on for hematological disease between January 1993 and December 2009. RESULTS There were 47 anterior and 37 lateral approaches. Sex, disease, median age, operative time, blood lost or hospital stay, and associated laparotomy were not different between the two groups. Operative complications included hemorrhage (5), bowel injury (1), diaphragmatic wound (1), pancreas tail section (1), and parietal hematoma (1) in the anterior group (9 cases) versus 1 hemorrhage in the lateral group (P<.02). There were five laparotomies owing to surgical complications in the anterior group, and none in the lateral group. CONCLUSION Splenectomy through laparoscopic approach is an effective technique. Lateral dissection of the vessels provides less operative complications in children.
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Pal K. Modified port placement and pedicle first approach for laparoscopic concomitant cholecystectomy and splenectomy in children. J Indian Assoc Pediatr Surg 2010; 15:93-5. [PMID: 21124663 PMCID: PMC2980930 DOI: 10.4103/0971-9261.71750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: Laparoscopy is becoming the preferred modality for concomitant cholecystectomy and splenectomy (CAS). Usually, six to seven ports are employed for CAS, and spleen is removed by classical lateral approach or anterior approach. We report here our modified five-port and pedicle first approach for CAS in children to minimize the intraoperative bleeding and maximize the access. Materials and Methods: Twenty-one children underwent laparoscopic CAS with this new approach and their data were recorded prospectively. Following cholecystectomy (with ports 1–4), left side was elevated by 30°. The spleen was lifted by a grasper/fan retractor through port no. 5. The pedicle was dissected and splenic vessels were divided by ligasure (vessels < 8 mm), and for bulkier pedicle, vascular endo-GIA stapler was used. Short gastric and gastrosplenic ligament, lower pole and phrenico-colic attachments and upper pole attachments were dissected by ligasure in that sequence. Spleen was placed in endosac and delivered by digital fracture technique. Occasionally, lower transverse incision was made to deliver a massive spleen. Results: There were 12 males and 9 females with an average age of 8 years. Fourteen had sickle cell disease (SCD) and 7 had SCD and beta thalassemia. All CAS were completed successfully without any complication. Total duration was 160 minutes. Cholecystectomy took an average of 35 minutes. Average blood loss was 140 ml. The mean splenic weight was 900 g and mean length was 20 cm. Duration of hospitalization was 3–4 days. Conclusion: CAS can be successfully performed by five ports. The pedicle first approach is extremely helpful in moderate to massive spleens as it reduces splenic size, vascularity and bleeding from capsular adhesions or inadvertant lacerations.
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Affiliation(s)
- Kamalesh Pal
- Department of Surgery, King Fahad Hospital of the University, College of Medicine, University of Dammam, Al Khobar, Kingdom of Saudi Arabia
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Yodonawa S, Goto Y, Ogawa I, Yoshida S, Itoh H, Nozaki R, Kato A, Takahashi M. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura in a woman with situs inversus: Report of a Case. Surg Today 2010; 40:1176-8. [PMID: 21110165 DOI: 10.1007/s00595-009-4183-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 08/05/2009] [Indexed: 11/28/2022]
Abstract
A 51-year-old woman with previously diagnosed situs inversus (SI) totalis was admitted to our hospital with nasal bleeding. Blood tests showed severe thrombocytopenia, with a platelet count of 1.9 × 104/mm(3), and idiopathic thrombocytopenic purpura (ITP) was diagnosed. She was refractory to medical treatment, so we performed laparoscopic splenectomy (LS). The mirrorimage anatomy made the procedure difficult for the right-handed surgeon, so we modified the technique to enable it to be performed via an anterior approach through the subxiphoid area using the right hand, with an ultrasonic dissecting device and an endostapling device. The operation was performed safely, the patient recovered uneventfully, and her platelet count normalized. To our knowledge, there has been no other report of LS in a patient with SI; however, it can be performed safely with careful management.
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Affiliation(s)
- Satoshi Yodonawa
- Department of Surgery, Ibaraki Seinan Medical Center Hospital, 2190 Sakai-machi, Sashima-gun, Ibaraki, 306-0433, Japan
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Nursal TZ, Ezer A, Belli S, Parlakgumus A, Caliskan K, Noyan T. Reaching proficiency in laparoscopic splenectomy. World J Gastroenterol 2009; 15:4005-8. [PMID: 19705495 PMCID: PMC2731950 DOI: 10.3748/wjg.15.4005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.
METHODS: All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n = 33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups.
RESULTS: There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further. There was no difference between the groups regarding the other parameters.
CONCLUSION: Unlike the widely accepted “L” shape, the learning curve for laparoscopic splenectomy is a horizontal lazy “S” with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.
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Kawanaka H, Akahoshi T, Kinjo N, Konishi K, Yoshida D, Anegawa G, Yamaguchi S, Uehara H, Hashimoto N, Tsutsumi N, Tomikawa M, Koushi K, Harada N, Ikeda Y, Korenaga D, Takenaka K, Maehara Y. Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism. ACTA ACUST UNITED AC 2009; 16:749-57. [PMID: 19629372 DOI: 10.1007/s00534-009-0149-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension. METHODS From 1993 to 2008, 265 cirrhotic patients underwent LS. Child-Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or =1,000 mL), perisplenic collateral vessels, or Child-Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed. RESULTS There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients (P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min (P < 0.01) and from 506 to 171 g (P < 0.01), respectively. CONCLUSIONS With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.
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Affiliation(s)
- Hirofumi Kawanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Ayiomamitis GD, Alkari B, Owera A, Ammori BJ. Emergency Laparoscopic Splenectomy for Splenic Trauma in a Jehovah's Witness Patient. Surg Laparosc Endosc Percutan Tech 2008; 18:626-30. [DOI: 10.1097/sle.0b013e31818133c6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
For years splenectomy in hepatic disorders has been indicated only for the treatment of gastro-esophageal varices. However, with recent advances in medical and surgical treatments for chronic hepatic disorders, the use of splenectomy has been greatly expanded, such that splenectomy is used for reversing hypersplenism, for applying interferon treatment for hepatitis C, for treating hyperdynamic portal circulation associated with intractable ascites, and for controlling portal pressure during small grafts in living donor liver transplantation. Such experiences have shown the importance of portal hemodynamics, even in cirrhotic livers. Recent advances in surgical techniques have enabled surgeons to perform splenectomy more safely and less invasively, but the procedure still has considerable clinical outcomes. Splenectomy in hepatic disorders may become a more common procedure with expanded indications. However, it should also be noted that the long-term effects of splenectomy, in terms of improved hematological or hepatic function, is still not guaranteed. Moreover, the impact of splenectomy on immunologic status remains unclear and needs to be elucidated in both experimental and clinical settings.
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Affiliation(s)
- Toru Ikegami
- The Department of Surgery, the University of Tokushima, Tokushima, Japan
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21
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Matsuoka S, Uchida K, Tominaga Y, Uno N, Simabukuro S, Hiramitsu T, Goto N, Sato T, Nagasaka T, Watarai Y. Modified laparoscopic splenectomy: a beneficial technique for ABO-incompatible living donor renal transplantation candidates on hemodialysis. Ther Apher Dial 2008; 12:381-4. [PMID: 18937721 DOI: 10.1111/j.1744-9987.2008.00613.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Advances in laparoscopy have enabled minimally invasive surgical treatment of splenic diseases. Even with these advances, laparoscopic splenectomy in patients on dialysis can be difficult because of tissue fragility due to the underlying renal disease. We report a safe surgical technique for laparoscopic splenectomy in patients on maintenance dialysis that is suitable for use before ABO-incompatible living donor renal transplantation (LDRTx). Between June 1972 and December 2006, a total of 800 patients underwent LDRTx in our department, including 82 patients who underwent ABO-incompatible LDRTx. Between April 2001 and December 2006 we performed laparoscopic splenectomy in 48 hemodialysis patients as a pretreatment before ABO-incompatible LDRTx. Under general anesthesia the operation was performed using a new technique, referred to as the "splenic hilum lump method." We evaluated the surgical outcomes, such as the operative time, amount of blood loss, efficacy, and complications. The mean operative time was 131.6 +/- 38.4 min and mean blood loss was 126 +/- 395 mL. Blood transfusion was required in three patients. All cases had satisfactory kidney function after LDRTx and none developed kidney graft failure due to acute rejection. Almost all patients could walk the day after laparoscopic splenectomy and were satisfied with the cosmetic appearance of the scar after wound healing. The surgical technique we report here can be safely performed on patients with renal failure who require caution because of tissue fragility. Laparoscopic splenectomy is a safe, effective and less invasive operative procedure as a pretreatment for ABO-incompatible LDRTx.
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Affiliation(s)
- Susumu Matsuoka
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
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22
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Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2008; 22:821-48. [PMID: 18293036 DOI: 10.1007/s00464-007-9735-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 11/23/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude laparoscopic splenectomy are not clearly defined. In view of this, the European Association for Endoscopic Surgery (EAES) has developed clinical practice guidelines for LS. METHODS An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. A consensus development conference using a nominal group process convened in May 2007. Its recommendations were presented at the annual EAES congress in Athens, Greece, on 5 July 2007 for discussion and further input. After a further Delphi process between the experts, the final recommendations were agreed upon. RESULTS Laparoscopic splenectomy is indicated for most benign and malignant hematologic diseases independently of the patient's age and body weight. Preoperative investigation is recommended for obtaining information on spleen size and volume as well as the presence of accessory splenic tissue. Preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections is recommended in elective cases. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and prolonged anticoagulant prophylaxis to high-risk patients. The choice of approach (supine [anterior], semilateral or lateral) is left to the surgeon's preference and concomitant conditions. In cases of massive splenomegaly, the hand-assisted technique should be considered to avoid conversion to open surgery and to reduce complication rates. The expert panel still considered portal hypertension and major medical comorbidities as contraindications to LS. CONCLUSION Despite a lack of level 1 evidence, LS is a safe and advantageous procedure in experienced hands that has displaced open surgery for almost all indications. To support the clinical evidence, further randomized controlled trials on different issues are mandatory.
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Affiliation(s)
- B Habermalz
- Institute for Research in Operative Medicine, University Witten/Herdecke, Witten/Herdecke, IFOM, Ostmerheimer Strasse 200, 51109, Köln, Germany
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23
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Laparoscopic splenectomy by secondary pedicle division strategy: a highly cost-effective method. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200801020-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Romano F, Gelmini R, Caprotti R, Andreotti A, Guaglio M, Franzoni C, Uggeri F, Saviano M. Laparoscopic Splenectomy: Ligasure Versus EndoGIA: A Comparative Study. J Laparoendosc Adv Surg Tech A 2007; 17:763-7. [DOI: 10.1089/lap.2007.0005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Fabrizio Romano
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Roberta Gelmini
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Caprotti
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Alessia Andreotti
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Guaglio
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Chiara Franzoni
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Uggeri
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Massimo Saviano
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Konstadoulakis MM, Lagoudianakis E, Antonakis PT, Albanopoulos K, Gomatos I, Stamou KM, Leandros E, Manouras A. Laparoscopic versus open splenectomy in patients with beta thalassemia major. J Laparoendosc Adv Surg Tech A 2006; 16:5-8. [PMID: 16494539 DOI: 10.1089/lap.2006.16.5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Laparoscopic splenectomy is considered the standard of care for the removal of the spleen in benign diseases. There are not sufficient data for the routine application of this technique in patients with beta thalassemia major. MATERIALS AND METHODS Twenty-eight consecutive beta thalassemia major patients who underwent elective splenectomy were randomized for open and laparoscopic splenectomy. Patient demographics, operative time, intraoperative and postoperative complications, conversion rate, transfusions, and length of stay were recorded. RESULTS There was no mortality in this series. There was no difference in complication rates between the two groups. Operative time was markedly increased in the group treated laparoscopically, as was the need for blood transfusions. Median hospital stay was decreased in the laparoscopic group (5 days) compared to the open group (6.5 days). CONCLUSIONS Laparoscopic splenectomy in patients with beta thalassemia major is feasible; however, it is more time consuming and bleeding occurs more often.
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Affiliation(s)
- Manousos M Konstadoulakis
- First Department of Propaedeutic Surgery, Hippokrateion Hospital of Athens, Athens Medical School, Athens, Greece.
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Zacharoulis D, O'Boyle C, Royston CMS, Sedman PC. Splenic retrieval after laparoscopic splenectomy: a new bag. J Laparoendosc Adv Surg Tech A 2006; 16:128-32. [PMID: 16646702 DOI: 10.1089/lap.2006.16.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Laparoscopic splenectomy has become the gold-standard surgical approach for patients undergoing elective splenectomy. Little data exist concerning the technical difficulties of splenic retrieval. When the spleen is large, popular commercial retrieval bags are often too small to facilitate removal. The aim of this study was to compare our clinical experience utilizing two different retrieval bags, the Endocatch II (Autosuture, London, UK) and the developing E200 (Espiner Ltd., Bristol, UK). MATERIALS AND METHODS We performed a retrospective review of all laparoscopic splenectomies performed at Hull Royal Infirmary, Kingston upon Hull, from March 1997 to July 2003. Patient demographics, morbidity, mortality, and clinical outcome had been entered prospectively into a database. Two patient groups were examined, depending on the type of retrieval bag utilized. Complications and instrument failure during splenic retrieval were analysed. RESULTS A total of 83 laparoscopic splenectomies were performed. No retrieval bag was used in 8 cases (10%). The Endocatch retrieval bag was used for 45 (60%) patients and the E200 for 30 (40%) patients. The mean operative time for the former group was 65 minutes (range, 50-127 minutes) and for the latter, 120 minutes (range, 80-180 minutes) (P < 0.05). Bag-related complications were 2 (4%) perforations and 2 (4%) failures to deploy while using the Endocatch bag. CONCLUSION The Endocatch bag is easy to deploy but is associated with perforation and cannot be used for large spleens. The E200 bag is more useful for large spleens but is associated with prolonged operative time due to poor maneuverability. Improved technology is still required.
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Affiliation(s)
- Dimitris Zacharoulis
- Division of Upper Gastrointestinal and Minimally Invasive Surgery, Hull Royal Infirmary, Hull, United Kingdom
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Gelmini R, Romano F, Quaranta N, Caprotti R, Tazzioli G, Colombo G, Saviano M, Uggeri F. Sutureless and stapleless laparoscopic splenectomy using radiofrequency: LigaSure device. Surg Endosc 2006; 20:991-4. [PMID: 16738999 DOI: 10.1007/s00464-005-0470-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 12/18/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bleeding is the main complication and cause of conversion during laparoscopic splenectomy (LS). We present the advantages of the LigaSure vessel sealing system added to the lateral approach for achieving safe vascular control. METHODS We performed 63 consecutive LS in a 3-year period using LigaSure in two affiliated university hospitals. We employed a right semilateral position technique with dissection of the spleen and vessel sealing using LigaSure. Forty-two patients had benign hematological disease, 19 had malignant disease, and two had splenic cysts. RESULTS A total of 58 LS were completed with five conversions due to hilar bleeding (three cases), difficult dissection (one), and massive splenomegaly (one). In all but five patients, blood loss was less than 100 ml. No transfusions were needed. There were five postoperative complications: portal thrombosis (one case), hemoperitoneum (two), surgical wound infection (one), and pleural effusion (one). CONCLUSIONS The use of LigaSure, and the semilateral position, results in a gain of time and safety. Furthermore, average intraoperative bleeding is very low.
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Affiliation(s)
- R Gelmini
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, via del Pozzo, 71 - 41100, Modena, Italy.
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Machado MAC, Makdissi FF, Herman P, Montagnini AL, Sallum RAA, Machado MCC. Exposure of splenic hilum increases safety of laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech 2004; 14:23-5. [PMID: 15259581 DOI: 10.1097/00129689-200402000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Laparoscopic splenectomy is becoming the gold standard technique for the treatment of hematological disorders of the spleen. Hemostasis is a fundamental step during laparoscopic splenectomy leading some authors to develop several techniques to control splenic vessels such as hand assistance, preoperative splenic artery embolization, and the use of vascular linear staplers. However, intraoperative bleeding is usually due to inadequate exposure of the hilar splenic vessels itself. The authors describe a standardized technique for the exposure of splenic pedicle using an endoscopic triangular retractor. We have been used this technique in 16 consecutive laparoscopic splenectomies with minimal blood loss. The present technique may increase the safety of laparoscopic splenectomy with adequate exposure of the splenic hilum reducing the conversion rate and intraoperative blood loss.
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Edwin B, Skattum X, Rãder J, Trondsen E, Buanes T. Outpatient laparoscopic splenectomy: patient safety and satisfaction. Surg Endosc 2004; 18:1331-4. [PMID: 15803231 DOI: 10.1007/s00464-003-9174-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 01/10/2004] [Indexed: 02/08/2023]
Abstract
BACKGROUND We assessed the feasibility of outpatient laparoscopic splenectomy, as performed by an experienced laparoscopic term and combined with optimal anesthesia. METHODS Inclusion criteria in the study was limited to patients not hospitalized before the procedure who had hematological or neoplastic indications for splenectomy and were classified as American Society of Anesthesiologists (ASA) I-III. They received general intravenous anesthesia with propofol and remifentanil and were given keterolac, propacetamol, droperidol, and ondansetron as prophylaxis against postoperative pain and nausea. Laparoscopic splenectomy was performed via three trocars. The specimen was removed via an incision in the left iliac fossa. RESULTS Ten of the 12 patients were discharged 3-6 h postoperatively; the other two were admitted primarily to hospital. One was readmitted due to a fever, which was finally explained by measles. The median operative times was 58 min (range, 45-135). Patient satisfaction was excellent in nine and intermediate in two cases; it was poor in one case, due to postoperative pain. CONCLUSION Laparoscopic splenectomy can be completed in a relatively short time; therefore, it is feasible, safe, and satisfactory for most patients as an outpatient procedure.
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Affiliation(s)
- B Edwin
- Interventional Center, National Hospital, 0407, Oslo, Norway
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Smith L, Luna G, Merg AR, McNevin MS, Moore MR, Bax TW. Laparoscopic splenectomy for treatment of splenomegaly. Am J Surg 2004; 187:618-20. [PMID: 15135677 DOI: 10.1016/j.amjsurg.2004.01.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Revised: 01/19/2004] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic splenectomy presents an advantage over open splenectomy, resulting in shorter hospital stay, decreased blood loss, and fewer operative and postoperative complications. Splenomegaly has long been considered a contraindication for laparoscopic splenectomy; however, in the hands of an experienced surgeon, this technique can be effectively applied to the treatment of splenomegaly. METHODS Records for patients undergoing laparoscopic splenectomy for splenomegaly between 2000 and 2003, performed by a single surgeon in three community-based hospitals, were reviewed and demographic, operative, and postoperative data compiled. Preoperative diagnoses included B cell lymphoma, hemolytic anemia, and chronic lymphocytic leukemia. RESULTS Seven patients underwent laparoscopic and hand-assisted laparoscopic splenectomy for splenomegaly during this time period. Splenic weights ranged from 410 to 3,100 g, and average operative time was 86.6 minutes. Estimated blood loss ranged from 50 to 350 ml; average hospital stay was 4.4 days. Two postoperative complications, ie, postoperative bleeding and superficial wound breakdown, were noted. CONCLUSIONS Laparoscopic and hand-assisted laparoscopic splenectomy are effective methods for treatment of splenomegaly.
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Affiliation(s)
- Leah Smith
- Associated Surgeons, P.S., 104 West 5th Ave., Suite 350E, Spokane, WA 99204, USA
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