Conventional Laparoscopic Splenectomy Research Articles

Hand-Assisted Laparoscopic Splenectomy with Temporary Splenic Artery Occlusion in Pediatric Patients: The Experience in a Chinese Tertiary Children's Hospital.

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.

Splenectomy in Gaucher Disease: A Call for Minimally Invasive Surgery.

The objective of this article was to demonstrate that Gaucher disease (GD) patients with refractory hypersplenism and massive splenomegaly may successfully undergo hand-assisted laparoscopic splenectomy (HALS). This was a retrospective audit conducted at the Gaucher clinic at a national referral center over a 10-year period. This study included 8 GD patients who underwent hand-assisted or conventional laparoscopic splenectomy for massive or complicated splenomegaly between the years 2007 and 2017. Seven patients underwent an elective HALS procedure because of refractory hypersplenism, whereas 1 patient underwent an urgent conventional laparoscopic splenectomy because of torsion of a wandering spleen. Only 1 patient required conversion to open surgery because of multiple adhesions from a previous partial splenectomy. The mean weight of the removed spleens was 2373 g (range, 480 to 4900 g), mean craniocaudal length of the removed spleens was 25 cm (range, 20 to 33.5 cm), and mean operating time was 150 minutes (range, 96 to 280 min). Postoperative complications were limited to 2 patients and included thrombosis of the splenic vein stump in 1 patient, and propagation of a preoperative splenic vein thrombus to the portal system, as well as an accumulation of an intra-abdominal hematoma in another patient. There was no mortality. Mean length of hospital stay was 5 days (range, 2 to 11 d). HALS for GD patients with refractory hypersplenism and massive splenomegaly is safe and feasible in experienced hands.

Vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection.

Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD. We retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD (n = 40) or VLSD (n = 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared. No patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time (P = 0.020) and less postoperative complications (P < 0.0001), including less diarrhea (P < 0.0001), epigastric fullness (P < 0.0001), and delayed gastric emptying (P < 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all P < 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups. VLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life.

Minimally Invasive Splenectomy for splenomegaly by traditional technique:A comparative study with conventional laparoscopic Splenectomy

Minimally invasive surgery is a well known advantageous technique to all health systems, it is still possible to do minimal invasive technique, without using expensive equipments and its burden regarding; cost, maintenance and other disadvantages. This study was performed to compare minimally invasive surgery with classical traditional surgical technique in the aspects of reduced post-operative pain, shorter hospital stay and shorter convalescence period. In this study our cases underwent splenectomy through small incisions, which are almost equal to laparoscopic procedures and compared to equal number of cases underwent splenectomy through classical traditional technique. Decisions for splenectomy were made by physicians for a variety of well known disease status that complete cure or improvement will be gained by splenectomy. In this study, eighteen cases were studied, from which nine were males (mean age34.3±20.45) and nine were females (mean age=21.6±15.99). Nine of them were underwent splenectomy through minimally invasive incisions, the other group splenectomized through classical traditional incisions. The first group was discharged earlier; need much lesser narcotic medication and shorter convalescence period. In summary, compared to conventional classical method approach, Minimally Invasive Splenectomy is significantly facilitates the surgical procedure, reduces the risk and difficulty in the cases of splenomegaly. So this technique is more feasible and more effective than conventional clasical method for the removing of the splenomegaly.

Single-Port Laparoscopic Splenectomy as an Alternative for Conventional Laparoscopic Splenectomy

Introduction: Laparoscopic splenectomy is developing as the gold standard for the management of splenic disorder. The concept of minimal-invasive surgical techniques has progressed since the early 1990s from the standard multiport laparoscopy to the natural orifice transluminal endoscopic surgery and recently, to single-port laparoscopic surgery. Aim: To assess the feasibility and safety of transumbilical single port laparoscopic splenectomy. Patients and methods: Between September 2013 and August 2016, transumbilical single-port splenectomy was performed on 13 patients via a 2.5 cm curved incision at the lower umbilicus edge, and special single incision laparoscopic surgery (SILS™) port (Covidien, Mansfield, MA) was introduced through which splenectomy was done. Results: A total of fifteen patients underwent minimally invasive splenectomy. There were 3 conversions to multiport laparoscopic splenectomy. The operative time was (123.07±16.7). Conclusion: Single port laparoscopic splenectomy is safe and feasible and could be a logical alternative to classical laparoscopic splenectomy.

Natural orifice transumbilical versus conventional incision laparoscopic splenectomy: a comparative study

Objective To study the feasibility, safety, operative skills and clinical advantage of natural orifice transumbilical laparoscopic splenectomy. Methods The clinical data of patients who underwent natural orifice transumbilical laparoscopic splenectomy (group A, n=9) and conventional laparoscopic splenectomy (group B, n=15) in our department from Nov. 2011 to Nov. 2014 were reviewed. The operative time, estimated blood loss, post-operation complications, hospital stay, incision satisfaction score and total cost were compared between two groups. Patients with immune thrombocytopenia, presume hereditary splecocytosis and idiopathic hypersplenism were included. Results All the procedures were successfully carried out laparoscopically. The estimated blood loss and total cost showed no significant differences between group A and group B [(196.7±118.7) ml vs (188.7±110.8) ml; (3.7±0.5) vs (3.6±0.7)×104 yuan, P>0.05]. As to the incision satisfaction score, group A was superior to group B [(4.1±0.6) vs (3.4±0.7), P<0.05]. The operation time of group A was significantly longer than that of group B [(201.7±43.2) min vs (131.0±37.1) min, P<0.05]. Conclusion Natural orifice transumbilical laparoscopic splenectomy is a safe and feasible procedure with better satisfactory clinical outcomes than conventional laparoscopic splenectomy. Key words: Laparoscopic splenectomy, transumbilical, concealed approach, conventional approach

Hand‐assisted versus conventional laparoscopic splenectomy: a systematic review and meta‐analysis

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). 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. 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). 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.

Clinical study of free auxiliary device of hand assisted laparoscopic splenectomy and intraoperative autologous splenic blood transfusion

Objective To investigate the feasibility and advantage of hand assisted laparoscopic splenectomy for giant spleens without auxiliary device and the clinical value of intraoperative autologous splenic blood transfusion.Methods From October 2007 to October 2011,48 cases of liver cirrhosis splenomegaly were analyzed retrospectively according to operation method including hand assisted laparoscopic splenectomy group with free auxiliary device (HALS) (n =30) and conventional laparoscopic splenectomy (CLS) (n =12),and they were divided into two groups:severe splenomegaly group (the length of the spleen more than 20 cm) and moderate splenomegaly (the length of the spleen less than 20 cm).The intraoperative bleeding,operation time,the spleen removal time and transit operation rate were compared in these patients.The blood transfusion machine was used for autologous splenic blood transfusion.Results Free auxiliary device saved at least 2000 yuan without affecting the maintenance of pneumoperitoneum during operation.There was no significant difference in the average blood loss between HALS group and CLS group [(88.1 ± 16.3) ml vs.(107.5 ± 11.6) ml,P ＞0.05].The average operation time was significantly shorter [(75.2 ± 13.3) min vs.(120.7 ± 20.5) min,P ＜ 0.05],and the spleen removal time was markedly shorter [(8.0 ±3.1) min vs.(25.2 ±2.8) min,P ＜0.05] in HALS group than in CLS group.The transit operation rate of severe splenomegaly (50％) was significantly higher than moderate splenomegaly (20％) (P ＜ 0.01),and the intraoperative bleeding too [(103.8 ± 25.0) ml vs.(70.4 ± 10.3) ml,P ＜0.01].Intraoperative autologous splenic blood transfusion significantly elevatedf hemoglobin level on the first day after operation [(2.07 ± 0.25) g/L,P ＜ 0.05].Conclusion HALS significantly facilitates the surgical procedure and reduces the operational risk,while maintaining the advantages of CLS.Hand-assisted laparoscopic splenectomy is a safe and effective technique especially for the management of severe splenomegaly.Intraoperative autologous splenic blood transfusion shows obvious special advantage in ascending hemoglobin. Key words: Hand-assisted laparoscopic splenectomy; Splenomegaly; Splenic blood transfusion

Feasibility and safety of single-incision laparoscopic splenectomy: a systematic review

ObjectiveThe aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic splenectomy (SILS-Sp). MethodsWe conducted a systemic review of literature between 2009 and 2012 to retrieve all relevant articles. ResultsA total of 29 studies with 105 patients undergoing SILS-Sp were reviewed. Fifteen studies used a commercially available single-port device. The range of body mass index was 14.7–41.4 kg/m2. Six studies described combined operations including cholecystectomy (n = 8), mesh-pexy (n = 1), and pericardial devascularizaion (n = 1). The ranges of operative times and estimated blood losses were 28–420 min and 0–350 mL, respectively. Of 105 patients, three patients (2.9%) required additional ports, two patients (1.9%) were converted to open, and three patients (2.9%) to conventional multiport laparoscopic splenectomy (overall conversion rate, 4.8%). Postoperative bleeding occurred in two patients (1.9%) who both required reoperation. Overall mortality was 0% (0/105). The length of postoperative stay varied across reports (1–11 d). Among four comparative studies, one showed greater estimated blood loss and lower numeric pain rating scale score in the SILS-Sp group than in the multiport laparoscopic splenectomy group (206.25 ± 142.45 versus 111.11 ± 99.58 mL) and (3.81 ± 0.91 versus 4.56 ± 1.29), respectively. Another comparative study showed that SILS-Sp was associated with a shorter operative time (92.5 versus 172 min; P = 0.003), lower conversion rate, equivalent length of hospital stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements. ConclusionsIn early series of highly selected patients, SILS-Sp appears to be feasible and safe when performed by experienced laparoscopic surgeons. However, as an emerging operation, publication bias is a factor that should be considered before we can draw an objective conclusion.

Reduced port laparoscopic splenectomy using a newly developed multichannel port: A pilot study

Background: The authors introduce the dual-incision laparoscopic splenectomy (DILS) technique using a specially designed multichannel trocar and report on the surgical outcomes and operative cost of DILS compared with conventional laparoscopic splenectomy (CLS). Material and methods: The medical records of 53 patients who underwent a laparoscopic splenectomy using CLS with four trocars and DILS at our institution were analyzed. Results: There was no statistical difference in operative time between the two groups and the intraoperative transfusion rate of red blood cell substitution was not different between the two groups. In terms of postoperative pain score, hospital stay, and overall complication rate, there were no differences between the two groups. Operative cost was significantly lower in the DILS group compared with the CLS group. Conclusions: DILS is a feasible and cost-effective modality of reduced port surgery in laparoscopic splenectomy.

Single-Incision Pediatric Endosurgery (SIPES) Splenectomy: A Case-Control Series

Single-incision pediatric endosurgery (SIPES) is gaining popularity. The aim of this study was to review the authors' experience with SIPES splenectomy and compare it with conventional laparoscopic splenectomy. After institutional review board approval, data on SIPES splenectomy in children were collected prospectively. The study group was compared with a control group of patients who were retrospectively identified as having undergone conventional laparoscopic splenectomy during the same time period. Sixteen children underwent SIPES splenectomy. Ages ranged from 1 to 15 years, with a median of 7 years, and weights were between 10 and 70 kg, with a median of 24 kg. The control group was similar in age and weight characteristics. The most common diagnoses were hereditary spherocytosis, sickle cell disease, and immune thrombocytopenic purpura. There were two conversions to open splenectomy in the SIPES group and one in the laparoscopic group. Operative times were 40-190 minutes (median, 84 minutes) in the SIPES group and 51-154 minutes (median, 99 minutes) in the conventional laparoscopic group. The SIPES technique is well suited for splenectomy. Despite instruments and camera being in-line, working angles are not compromised, and visualization is adequate. Operating time and hospital stay are comparable to those with standard laparoscopic splenectomy, but the cosmetic result may be superior.

Single incision versus reduced port splenectomy—searching for the best alternative to conventional laparoscopic splenectomy

Laparoscopic splenectomy (LS) is a well accepted approach for the treatment of multiple hematologic diseases. Single port access splenectomy (SPAS) emphasizes the concept of surgery through one small incision. The reduced port access splenectomy (RPAS) entails the use of fewer trocars of smaller sizes. The aim of this study was to compare the clinical outcomes after LS, SPAS, and RPAS, and to analyze the aesthetic result and patient satisfaction. We included patients who underwent LS (group 1, n = 15), SPAS (group 2, n = 8), and RPAS (group 3, n = 10) between June 2008 and February 2012, whose final spleen weight was less of 500 g. The outcome parameters analyzed were operative time, need of additional trocars, blood loss, blood transfusion, weight of the spleen, postoperative complications, and duration of hospital stay. To evaluate the cosmetic result, patients were asked to take the Body Image Questionnaire. Patients in group 3 were younger than group 1. Operative time was significantly longer in group 2 compared to groups 1 and 3 (83 ± 19 vs. 131 ± 43 vs. 81 ± 22 min, p = 0.01). There was no need to convert to open surgery in any group, nor were there differences in intra- or postoperative outcome. There were no differences between the groups in relation to the analgesic requirements. Twenty-two out of the 33 patients answered the questionnaire. There was a significant advantage in group 2 and 3 in the body image index with respect to group 1. There were no differences between groups 2 and 3 (7.3 ± 2.8 vs. 5.8 ± 1.3 vs. 5.1 ± 0.4, p < 0.02). RPAS is a good alternative to LS and SPAS. It improves the aesthetic results as compared to LS, whereas minimizes the technical challenges faced with SPAS.

Comparison between single and three portal laparoscopic splenectomy in dogs

BackgroundSingle incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments.ResultsAll dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P < 0.001). There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches.ConclusionThis study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog.

Morbidity of hand-assisted laparoscopic splenectomy compared to conventional laparoscopic splenectomy: a 6-year review

Laparoscopic splenectomy (LS) has several advantages over the open procedure but can be technically demanding when performed in patients with massive splenomegaly. We hypothesized that patients who undergo hand-assisted LS (HALS) may experience the benefits of LS while having their enlarged spleens removed safely. We reviewed the charts of patients who underwent HALS or LS between January 2003 and June 2008. Evaluated parameters included intraoperative and early postoperative morbidity and mortality, conversion to open surgery, need for blood transfusion, length of postoperative hospital stay, patient demographics, diagnosis leading to splenectomy, splenic weight and number of postoperative days to resuming normal diet. Differences were analyzed while controlling for splenic weight and malignant diagnosis using multiple linear and logistic regression analysis. In all, 103 patients underwent splenectomy (23 HALS, 80 LS). Patients who had HALS were older and had larger spleens, and a greater proportion had malignant diagnoses. We observed no significant differences in morbidity, conversion to open surgery or need for blood transfusion. The mean length of postoperative stay, duration of surgery and days to resuming full diet were longer in the HALS group. No patients died. No group differences were significant after controlling for splenic weight and malignant diagnosis. The morbidity associated with HALS is comparable to that with LS. The longer duration of surgery and hospital stay for HALS patients was likely related to greater splenic weight, older age and greater proportion of malignant diagnoses. Hand-assisted LS is a viable alternative to open surgery in patients with massive spleens.

Single-Incision Laparoscopic Splenectomy Versus Conventional Multiport Laparoscopic Splenectomy

The authors report their experience with single-incision laparoscopic splenectomy (SLS) and compare postoperative outcomes of conventional multiport laparoscopic splenectomy (MLS) with SLS in patients with spleen sizes ≤15 cm. Demographic, intraoperative, and postoperative data were analyzed retrospectively and compared between patients who underwent MLS from June 20, 2006, to July 9, 2009 (MLS group, 18 patients) and those who underwent SLS from July 28, 2009, to November 2, 2010 (SLS group, 16 patients). Blood loss was significantly greater in the SLS group than in the MLS group (206.25 ± 142.45 vs 111.11 ± 99.58 mL, respectively; P = .047). The Numeric Pain Rating Scale in the SLS group was significantly lower than in the MLS group (3.81 ± 0.91 vs 4.56 ± 1.29, respectively; P = .041). There were no significant differences between the groups for other variables. SLS is a feasible method with good cosmetic benefit and equivalent clinical outcomes as compared with MLS.

Reappraisal of Anterior Approach to Laparoscopic Splenectomy

Laparoscopic splenectomy has been accepted as the treatment of choice in managing spleen-associated pathologic conditions requiring splenectomy. We introduce our surgical technique of modified laparoscopic splenectomy and discuss its technical feasibility and safety. From March 2006 to March 2010, 38 patients underwent modified laparoscopic splenectomy. Mean operating time was 169.5 ± 109.6 minutes. Mean blood loss was 468 ± 971.5 mL. Intraoperative transfusions were given to 10 patients (25.6%). There was no case for open conversion. In learning curve analysis, outcomes significantly improved with the first 17 patients. When we compared first 27 cases of conventional laparoscopic splenectomy with recent cases of modified technique, the 2 groups showed no significant difference. The presented technique of modified laparoscopic splenectomy seems to be a feasible, easy, and safe procedure. It is also thought that surgical indication could be extended even to the splenomegaly by this technique.

Single-incision laparoscopic splenectomy for idiopathic thrombocytopenic purpura: Report of a case

We herein report a case of single-incision laparoscopic access (SILA) splenectomy for idiopathic thrombocytopenic purpura (ITP). A 24-year-old female patient with a diagnosis of ITP received corticosteroid therapy. However, as the side effects became serious, a splenectomy option was chosen. The SILA splenectomy using a transumbilical approach is cosmetically more attractive than a conventional laparoscopic approach, but it has an increased risk of major bleeding due to technical considerations. Therefore, we prioritized the patient's safety during the SILA splenectomy by choosing a left lower abdominal approach. The operating time was 123 min and blood loss was 1 ml. This was comparable to a conventional laparoscopic splenectomy. The present case appears to be the first SILA splenectomy reported in Japan. In our experience, a SILA splenectomy is feasible and safe, with favorable perioperative and shortterm patient outcomes. Further studies are necessary before the universal adoption of this new technique.

Laparoscopic Treatment of Splenomegaly

Hand-assisted laparoscopic surgery (HALS) is a safe therapeutic approach to remove megaspleens of any size. Conventional laparoscopic splenectomy for splenomegaly is difficult because of limited exposure and complex vascular control, with increased risk of intraoperative bleeding and conversion to open surgery. HALS can overcome some of these limitations, reducing the risk of conversion to open surgery and resulting in a postoperative course similar to that of conventional laparoscopy. Single-institution single-surgeon retrospective review. University hospital. An analysis was performed of all patients with splenomegaly (splenic weight, >700 g) seen during a 10-year period. Preoperative data, indications for splenectomy, splenic weight, operative variables, clinical outcome, and rates of conversion to open surgery, complications, and operative mortality were compared between patients undergoing HALS vs conventional laparoscopy. Splenomegaly was present in 85 patients, of whom 43 underwent HALS splenectomy and 42 underwent conventional laparoscopic splenectomy. The HALS group had larger spleens. Rates of conversion to open surgery and operative mortality were similar in the HALS group vs the conventional laparoscopy group (2.3% [1 of 43] vs 2.4% [1 of 42] and 2.3% [1 of 43] vs 0.0% [0 of 42], respectively), with no difference in hospital length of stay in the absence of morbidity. Portal system thrombosis was the most serious complication. HALS can minimize surgical trauma in patients with massive splenomegaly who otherwise would be candidates only for open surgery and results in a clinical outcome similar to that of conventional laparoscopy. With the availability of HALS, any patient with splenomegaly can be offered a minimally invasive surgical option. Portal system thrombosis is common, regardless of the surgical technique.

Laparoscopic Splenectomy using a Single Incision Access

Conventional laparoscopic splenectomy is now considered standard in splenectomy. The superior cosmetic result of single incision laparoscopic surgery (SILS) has seen an increasing interest in all areas of surgery, including splenectomy. Literature search was done, and 26 cases reported in literature were reviewed. Age of the patient, position, access technique, duration of surgery, intraoperative complications, postoperative hospital stay, cosmetic and patient/parents satisfaction were noted. Age range was from 7 months to 73 years with satisfactory outcome. Conclusion: Single incision splenectomy can be performed safely in patients of all ages. Immediate indicators show superior cosmetic outcome compared to conventional laparoscopic splenectomy, however, bigger series with long-term follow-up are required.

Vergleich der laparoskopischen Splenektomie in Steinschnittlage mit der Hanging-Spleen-Technik bei idiopathischer thrombozytopenischer Purpura

Laparoscopic splenectomy has become the gold standard intervention for elective splenectomy. Several techniques have been described, which differ in trocar localisations and patient positions. The hanging-spleen technique was examined in comparison to the conventional laparoscopic splenectomy in the supine position among the patient population in our institution over a period of 8 years. On the basis of a retrospective analysis, data were collected on all patients who underwent elective laparoscopic splenectomy for idiopathic thrombocytopenic purpura between May 1994 and April 2002 and were examined for operation time, blood loss and peri-operative complications. Two types of operation were compared, the conventional laparoscopic splenectomy in the supine position (group A) and the hanging-spleen technique (group B). Finally, the costs of materials of the two operation techniques were compared. For 51 patients (43.1 % men, 56.9 % women) (mean age: 45.5 ± 17.5 years) the mean operation times were 134.2 ± 47.3 min (group A) and 9.8 ± 39.9 min (group B). The mean blood losses were 691.3 ± 544.4 mL in group A and 638.3 ± 1050.6 mL in group B. The perioperative complications were 38.8 % in group A and 21.2 % in group B. There was no significant difference found for operation time, blood loss and perioperative complications in a multivariate analysis. The cost of materials was reduced in group B (use of Endo-GIA 42.4 % in group B, 100 % in group A). In group A 4 incisions, in group B 3 incisions were necessary. Regarding operation time, blood loss and perioperative complications the 2 laparoscopic techniques for splenectomy do not differ significantly. Merely reduced material costs and a reduction of incisions were found in patients -operated with the hanging-spleen technique. Whether the hanging-spleen technique is the method of choice will have to be shown by further prospective studies.