Laparoscopic removal of large spleens: Pfannenstiel incision as an alternative specimen extraction method

Abstract

Removing the extremely enlarged spleen from the abdominal cavity is a common technical problem in case of laparoscopic splenectomy ( LS). In general, the specimen is placed into a plastic bag and removed after morcellation. In case of massive splenomegaly , when the spleen weight is 1000-2000 grams, this method is often not feasible, because the spleen size is larger than the maximum capacity of the EndoBag. According to the literature in this case the splenic extraction was performed by specimen fragmentation in the abdominal cavity (risk of splenosis) or by a laparotomy. To solve this problem our team removes the specimen via a Pfannenstiel incision since 2009. Between January 1, 2002 and September 30, 2014, 74 LS procedures were performed at our department. The specimen was retrieved with morcellation in a conventional manner through the lateral port site in 56 cases, whereas in 12 cases, the large spleen was retrieved through a 10-12 cm long Pfannenstiel incision. The mean duration of surgery was 121 (50-220) minutes. In those cases where the specimen was retrieved through a Pfannenstiel incision the mean duration of surgery was significantly shorter (108 vs. 125 minutes; p=0.05), and the mean spleen size was significantly larger (1032 vs. 338 grams; p=0.0001) than in the case of morcellation. In the duration of the mean postoperative hospital stay there was no significant difference (4.7 vs. 5.2 days; p=0.178). Our study supports that laparoscopic splenectomy is safe and has numerous advantages even in the case of massive splenomegaly. The retrieval of the specimen through a Pfannenstiel incision is considered a safe and cosmetically acceptable alternative.