Learning curve of laparoscopic splenectomy for immune thrombocytopenic purpura

Abstract

Objective To evaluate the outcomes of laparoscopic splenectomy (LS) at different stages in patients with immune thrombocytopenic purpura(ITP), and to define the learning curve of LS. Methods The clinical data of 105 cases of LS performed for ITP by same surgeon between May 2003 and March 2010 were analyzed retrospectively. The cases were divided into group A, B and C with 35 cases in each group according to the sequence of hospitalization. The surgical outcomes of three group, including operative time, estimated intraoperative blood loss, estimated 48-hour volumes of postoperative drainage, major morbidity, and postoperative hospitalization time, were compared subsequently. Results No convertion to traditional operation was needed in all the patients. There were linear relationships between operative number and operative time or estimated intraoperative blood loss (correlation coefficients were -0.408 and -0.234, respectively, P<0.001 and 0.016, respectively). Operative times of three groups were (125.0±33.5) min, (111.8±26.3) min, and (100.1±25.7) min, respectively (P=0.002). Estimated intraoperative blood losses were (95.7±166.0) ml, (64.3±100.8) ml, and (38.3±34.3) ml, respectively(P=0.007). When comparing between two groups, statistical diferences of operative times and estimated intraoperative blood losses were found between goup A and C (P values were 0.001 and 0.002, respectively). There were no significant diferences of estimated 48-hour volumes of postoperative drainage, major morbidity, and postoperative hospitalization time among three groups. Conclusions LS for ITP is safe and feasible. Operative time and estimated intraoperative blood loss decrease significantly with the increase of operative number. The learning curve is about 35 cases to reach proficiency. Key words: Laparoscopic surgical procedures; Splenectomy; Autoimmune thrombocytopenic purpura; Learning Curve