Laparoscopic Splenectomy Procedures Research Articles

Comparison of Perioperative Results of Single Port Laparoscopic, Multiple Port Laparoscopic and Open Splenectomy in Patients with Non-Traumatic Splenic Diseases: Clinical Retrospective Trial

Introduction: The single-port laparoscopic splenectomy procedure is a brand new technique. Although it is reported that perioperative complications are less with conventional laparoscopy and open procedure, the number of studies comparing the perioperative outcomes of all three techniques is not high. This study compares the perioperative outcomes of these three splenectomy techniques in non-traumatic splenic diseases. Materials and Methods: Total number of 82 patients (aged 18-72 years ) who underwent splenectomy due to non-traumatic reasons between June 2011 and December 2016 in Ege University General Surgery Department were investigated, respectively. Patients were divided into three groups according to the procedure type, including single-port splenectomy (SILS), multiple port laparoscopic splenectomy (LS), open splenectomy (OS). Results: There was no significant difference in intraoperative bleeding and post-op complications between the three groups. Patients who underwent surgery due to ITP were respectively 26.4%, 91.2%, 80% in group 1,2 and 3 (P1 and p3>0.05). The mean operation times were respectively 81±17 min, 81±22 min, and 97±22 min in groups 1, 2, and 3 (p1 and p3>0.05, p2

Evaluation of 39 pediatric cases who underwent open and laparoscopic splenectomy: A retrospective cohort study

Aim: In children, aside from trauma-related splenic injury and splenic cysts, splenectomy is frequently performed in hematological diseases due to splenomegaly and thrombocytopenia. The most preferred method in children in the past years was open splenectomy. Today, laparoscopic splenectomy has become a preferred method by pediatric surgeons due to increasing laparoscopic surgical experience. The aim of this study is to present the results of the case series who underwent laparoscopic and open splenectomy in our clinic. Methods: All patients who underwent laparoscopic and open splenectomy between 2008-2019 in our clinic were included in the study. Four ports were used in the laparoscopic splenectomy procedure and port locations differed according to patient age and spleen size. The completely liberated spleen was taken into the specimen removal bag and removed after morcellation. Open surgical method was preferred in cases where the long axis of the spleen was 200 mm or higher. Demographic data, splenectomy indications, surgical techniques and postoperative follow-up data were evaluated retrospectively.Results: Splenectomy was performed laparoscopically in 24 of 39 patients (16 male, 23 female) and with the open method in 15 patients. Surgical indications included hereditary spherocytosis (n=15), idiopathic thrombocytopenic purpura (n=6), beta-thalassemia (n=3) in laparoscopically operated patients and hereditary spherocytosis (n=8), idiopathic thrombocytopenic purpura (n=4) and beta-thalassemia (n=3) in patients operated with the open method. Simultaneous cholecystectomy was performed in 11 cases due to cholelithiasis. The duration of the surgery was significantly longer [132 (47) and 90 (21) min., respectively P<0.001], and time until oral feeding [ 2.3 (0.8) and 3.9 (1.1) days, respectively P<0.001] as well as the length of hospitalization were significantly shorter in laparoscopic surgery compared to open surgery [3.80 (1.3) vs. 5.5 (1.2) days, respectively P<0.001]. Conclusion: Laparoscopic splenectomy is a safe method that should be preferred primarily in experienced centers for earlier feeding, shorter hospitalization times and better cosmetic results.

Fast-track care with intraoperative blood salvage in laparoscopic splenectomy

Fast-track surgery is claimed to reduce medical morbidity, eliminate the hospitalization needs, and shorten the convalescence period. Intraoperative bleeding as the main complication is also the primary cause of conversion from laparoscopic to open splenectomy. Intraoperative blood salvage can reduce transfusion requirements, decrease the conversion rate to open, and promote fast-tracking in laparoscopic splenectomy (LS). From November 2007 through December 2016 we collected medical data of 115 LS patients. There were three groups: 54 patients receiving routine care (we marks them as Group RT), 33 patients with fast-track care (Group FT), and 28 receiving fast-track care receiving intraoperative splenic blood salvage and autotransfusion (Group FT + ISBS). These medical data are comprised of included three phases (pre-, intra-, and postoperative). There were significant differences (P < 0.05) between RT, FT, and FT + ISBS groups. The hemoglobin level in Group FT + ISBS was significantly higher than in Group RT and Group FT. Comparing the duration of hospital stay of 3 groups, Group RT stayed for a significantly longer time than Group FT and Group FT + ISBS, Group FT + ISBSmuch shorter than Group FT. Comparing the hospitalization expense, GroupFT + ISBS significantly expended less than Group RT and Group FT. Our study shows that laparoscopic splenectomy with fast-track care is feasible, effective, and safe for patients who require splenectomy. Fast-tracking with intraoperative blood salvage improved the fast-track laparoscopic splenectomy procedure.

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

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.

Trends in splenectomy: where does laparoscopy stand?

Background and Objectives:Laparoscopic splenectomy (LS) has been shown to offer superior outcomes when compared to open splenectomy (OS). Despite the potential advantages associated with the minimally invasive technique, laparoscopy appears to be underused. We sought to evaluate the nationwide trends in LS.Methods:The Nationwide Inpatient Sample (NIS) database was queried for both OS and LS procedures performed from 2005 through 2010. Partial splenectomies and those performed for traumatic injury, vascular anomaly, or as part of a pancreatectomy were excluded. The included cases were examined for age of the patient and comorbid conditions. We then evaluated the postoperative complications, overall morbidity, mortality, and length of hospital stay.Results:A total of 37,006 splenectomies were identified. Of those, OS accounted for 30,108 (81.4%) cases, LS for 4,938 (13.3%), and conversion to open surgery (CS) for 1,960 (5.3%). The overall rate of morbidity was significantly less in the LS group than in the OS group (7.4% vs 10.4%; P < .0001). The LS group had less mortality (1.3% vs 2.5%, P < .05) and a shorter length of stay (5.6 ± 8 days vs 7.5 ± 9 days).Conclusions:Despite the benefits conferred by LS, it appears to be underused in the United States. There has been an improvement in the rate of splenectomies completed laparoscopically when compared to NIS data from the past (8.8% vs 13%; P < .05). The conversion rate is appreciably higher for LS than for other laparoscopic procedures, suggesting that splenectomies require advanced laparoscopic skills and that consideration should be given to referring patients in need of the procedure to appropriately experienced surgeons.

Laparoscopic Splenectomy: Ligasure Versus EndoGIA: A Comparative Study

Laparoscopic splenectomy (LS) is considered the gold standard for the treatment of hematologic disease of the spleen. Intraoperative bleeding is the main complication and main cause of conversion during LS. In this paper, we present our experience with 112 LS procedures, comparing two different techniques and instruments for spleen dissection and hilar vascular control. We have performed a total of 112 LS procedures in 9 years in two affiliated university hospitals. There were 48 males and 64 females (median age, 32.8 years). Indications were as follows: idiopathic thrombocytopenic purpura (ITP) in 42 patients, hereditary spherocitosis in 28, 6 with beta-talassemia, 1 with hemolitic anemia, 27 with lymphoma, 2 with leukemia, 3 with splenic cysts, and 3 PPT cases. Associated procedures were present in 25 cases (17 cholecystectomy and 4 liver/lymphnodal biopsies + lysis of adhesions). Patients were divided in two groups according to the method of dissection and hilar section (group 1, endostapler + monopolar coagulation with 38 patients; group 2, the Ligasure Vessel Sealing System (Valleylab, Boulder, CO) with 74 patients). Groups were well matched according to age, indications, spleen sizes, and procedures associated. Conversion rates (10 cases, 9%; 5 in each group), postoperative hospital stay (median 4 days in each group), and intra- and postoperative complications were similar in the 2 groups without any mortality in each group, while intraoperative blood loss (loss of 100 mL in 55 patients in group 2, 78%; and in 21 patients in group 1, 52%), transfusion rates (8 patients in group 1 versus 4 patients in group 2), and operative mean time (150 minutes in group 1 versus 125 minutes in group 2) were minor in the Ligasure Vessel Sealing System group, with a statistical significance. The approach to spleen dissection and hilum section was safe and efficacy in each case, otherwise the use of Ligasure results in a gain of time. Furthermore the average intraoperative bleeding and average transfusion rates of this series were lower in group 2.

Portal Vein Thrombosis After Laparoscopic Splenectomy in Benign Hematologic Diseases

Portal vein thrombosis is an unfrequent, but potentially deadly, complication of the laparoscopic splenectomy procedure. The laparoscopic approach has shortened the duration of hospital stay; portal vein thrombosis may appear after the patient has left the hospital, determining a later diagnosis. Because of the mild, nonspecific symptoms, the diagnosis can even be missed and only achieved when chronic complications take place. In this study, we aimed to determine the appearance of portal vein thrombosis in a consecutive series of patients who underwent laparoscopic splenectomy by performing a contrast-enhanced computed tomography (CT) scan postoperatively. A transversal study was established, performing in 2005 a contrast-enhanced CT scan on 20 patients who underwent laparoscopic splenectomy between 1999 and 2005 at Ramón y Cajal University Hospital (Madrid, Spain). The presence of thrombosis in the splenoportomesenteric axis was investigated. Two (2) cases (10%) of portal vein thrombosis were detected: 1 symptomatic case, 7 days after surgery, was treated with anticoagulation, resulting in the disappearance of the thrombus in a new CT scan 6 months later; the second case was asymptomatic and was discovered during the performance of this study. The contrast-enhanced CT scan shows the best accuracy for the diagnosis of portal vein thrombosis, and it must be performed when any clinical manifestation appear; also, it must still be determined if a contrast-enhanced CT scan should be systematically performed in high-risk thromboembolic patients. An ultrasound Doppler may present many diagnostic errors. It is probably advisable to prolong the antithromboembolic prophylaxis.

A Simple Technique for Deploying a Laparoscopic Bag During Splenectomy: Two-Point Anchoring to the Abdominal Wall

The deployment of a retrieval bag during a laparoscopic splenectomy procedure may be time-consuming. A simple technique of holding the bag open is described in this paper. A retrieval bag is equipped with two long, firm threads sutured to two preexisting tags on its opposite sides. The bag is introduced into the abdomen through the ports. By bringing the threads out of the abdomen through the abdominal wall and using one grasper, the surgeon can easily deploy the retrieval bag and hold it open. Our technique is easy to perform, and permits a rapid deployment and simple insertion of the spleen, while holding the retrieval bag wide open.

Concomitant intraoperative splenic artery embolization and laparoscopic splenectomy versus laparoscopic splenectomy: comparison of treatment outcome

Introduction Although laparoscopic splenectomy has become the preferred treatment of choice for hematologic-related splenic disorders, intraoperative blood loss remains a common occurrence. In an effort to reduce this risk, we evaluate the potential role and clinical outcome of concomitant intraoperative splenic artery embolization and laparoscopic splenectomy. Methods Between June 2000 and July 2005, 18 patients with hematologically related splenic disorders underwent combined intraoperative splenic artery embolization and laparoscopic splenectomy (group 1). For comparison, we studied 18 age- and gender-matched case controls undergoing same operations during the same period (group 2). Intraoperative data and clinical outcome were compared between the 2 groups. Results Technical success was 100% in group 1. One patient in group 2 was converted to open splenectomy because of severe blood loss, resulting in a technical success rate of 95%. The mean splenic size in group 1 and group 2 was 15.5 ± 4.7 cm (range, 12–23 cm) and 15.7 ± 6.8 (range, 11–24cm), respectively (not significant [NS]). Mean operative time in group 1 and group 2 was 175 minutes and 162 minutes, respectively (NS). Significantly less intraoperative blood loss was noted in group 1 (mean, 25 mL; range, 15–63 mL) compared with group 2 (mean, 240 mL; range, 150–420 mL; P < .003). There was an even greater difference in blood loss between the 2 groups when the splenic size was greater than 18 cm (mean 35 mL in group 1 versus 350 mL in group 2, P < .001). No differences were noted in postoperative recovery, return of bowel function, or length of hospital stay between the 2 groups. Conclusions Concomitant splenic artery embolization and laparoscopic splenic reduced operative blood loss when compared with laparoscopic splenectomy procedure alone. Splenic artery embolization is a useful intraoperative adjunctive procedure that should be considered in patients undergoing laparoscopic splenectomy for hematologic disorders who are Jehovah’s Witness or with significant hypersplenism because of benefit of reduced blood loss.

Splenectomy in children with idiopathic thrombocytopenic purpura: A prospective study of 134 children from the Intercontinental Childhood ITP Study Group

Splenectomy is an effective procedure for children and adults with severe or refractory idiopathic thrombocytopenic purpura (ITP). Data regarding pediatric patients are limited. Sixty-eight Intercontinental Childhood ITP Study Group (ICIS) investigators from 57 institutions in 25 countries participated in a splenectomy registry. Data from 153 patients were submitted, of whom 134 had a splenectomy and were analyzed. The median age at splenectomy was 11.8 (2.7-20.7) years. The median postsplenectomy follow-up was 2.0 (0.1-4.5) years. Pre-splenectomy vaccination was not administered in 21 children (15.7%). Open and laparoscopic splenectomy procedures were performed in 67 and 65 evaluable children, respectively. Surgical technique was not reported in two children. Overall immediate platelet response to splenectomy was achieved in 113 patients (86.3%). Eighty percent of responders maintained their status of response during the following 4 years. Older age, longer duration of ITP, and male gender correlated with a complete response. Post-splenectomy sepsis was reported in seven patients without lethal outcome, although sepsis might be differently defined at participating institutions. Splenectomy is effective in children with ITP. Management varies greatly in different institutions. These Registry data may serve as a basis for future clinical trials to assess the indication and timing of splenectomy.

Laparoscopic Splenectomy for Splenic Sequestration Crisis

Medical and surgical advances have improved the treatment of splenic sequestration crisis in pediatric patients with sickle cell disease (SCD). Rapid enlargement of the spleen can result from sickled blood cels being trapped in the spleen, which can be life threatening. The laparoscopic splenectomy procedure using the lateral approach has been adapted successfully for the pediatric patient since 1993. Children with SCD who have a history of a splenic sequestration crisis usually are scheduled for an elective splenectomy procedure after the first documented crisis to reduce the risk of death. Some key benefits of this new surgical approach include a shortened hospital stay, decreased postoperative pain, and faster recovery and return to normal activities for the child with SCD.

A case controlled comparison of open and laparoscopic splenectomy in children

Background: This case controlled study compares the efficacy, safety, and cost of laparoscopic splenectomy (LS) and open splenectomy (OS) for hematologic disorders in children. Methods: The records of 82 consecutive children and adolescents undergoing splenectomy for hematologic disorders between August 1994 and September 1997 were reviewed retrospectively. Results: Fifty patients underwent LS by a lateral approach and 32 underwent OS through a left subcostal incision. Mean age was 7.76 years for LS and 6.9 years for OS. Patient weights were similar: (LS, mean 30.5 kg; OS, mean 27.6 kg). Hematologic indications included hereditary spherocytosis in 43 children (LS 26, OS 17), sickle cell anemia with sequestration in 13 (LS 7, OS 6), immune thrombocytopenic purpura in 14 (LS 8, OS 6), and 12 with other disorders (LS 9, OS 3). Concomitant cholecystectomy was performed in 10 of 50 LS and 6 of 32 OS cases. Accessory spleens were identified in 8 of 32 (25%) OS and 9 of 50 (18%) LS cases (P =.578). No LS procedures required conversion to OS. The mean estimated blood loss was 54.4 mL for LS and 49.0 mL for OS (P =.233). LS required a longer operative time (115 vs 83 minutes, P =.002), less need for postoperative intravenous narcotic (51% vs 100%, P <.0001), lower total narcotic doses (0.239 vs 0.480 mg/kg morphine, P =.006), shorter length of hospital stay (1.4 ± 0.97 vs 2.5 ± 1.43 days, P =.0001), and lower average total hospital charges ($5713 vs $6564) than OS. There were no deaths or major complications in either group. Conclusions: Laparoscopic splenectomy is a safe and effective procedure in children with hematologic disorders resulting in longer operative times, less narcotic administration, shorter length of stay, and lower total hospital charge. (Surgery 1998;124:670-6.)

Laparoscopic splenectomy in children

To determine the safety and efficacy of laparoscopic splenectomy (LS) in children, a retrospective review of our preliminary experience using LS was compared to results in patients who previously underwent open splenectomy (OS). From July 1993 to January 1995, we performed eight LS procedures in six children with hereditary spherocytosis (HS) and two with immune thrombocytopenic purpura (ITP). Laparoscopic cholecystectomy was simultaneously done in one case with HS. There were 4 males and 4 females who ranged in age from 5 to 15 years--an average age of 8.8 years. Two cases in the early series required a counterincision because of bleeding. Eleven patients who previously underwent OS in our department were used to compare demographics, operative courses, and surgical outcomes. The ages, genders, diseases, body weights, and spleen weights were comparable between LS group and OS groups. The operative time for the LS group was statistically longer than for the OS group (226 +/- 24 min vs 101 +/- 8 min, P < 0.001). The estimated blood loss in the LS group was similar to that of the OS group (100 +/- 39 ml vs 73 +/- 11 ml. P = 0.97). There were no peri- or postoperative complications in two groups. The postoperative hospital stay of LS group was statistically shorter than that of the OS (6.8 +/- 0.6 days vs 10.4 +/- .05 days, P < 0.0001). LS provided better cosmesis and minimized trauma in children over OS. LS appears to be a safe and effective procedure in children, and is useful in the management of pediatric patients with HS or ITP.