Efficacy and safety of laparoscopic splenectomy: review of 14 adult cases using the lateral approach.

BACKGROUND

Laparoscopic splenectomy has advantages over conventional surgery mainly related to the smaller incision, less postoperative pain and shorter recovery period. The aim of this study was to assess the outcomes of patients with diseases of the spleen managed by elective laparoscopic splenectomy.

METHODS

Retrospective review of medical charts was performed of patients who underwent laparoscopic splenectomy by a single surgeon during a three year period. Patient demographics, diagnosis and outcomes including operative time, weight of the specimens, blood loss, operative complications, length of stay, and long term outcome with platelet counts in Immune Thrombocytopenic Purpura (ITP) were reviewed. Data on the presence of an accessory spleens, and need for use of hand assist devices was reviewed.

RESULTS

Fourteen patients underwent laparoscopic splenectomy; 9 (nine) for Immune Thrombocytopenic Purpura(ITP); one for Evans Syndrome, one for splenic artery aneurysm, two for suspected lymphoma and one for suspected metastatic disease. Ages were 22 to 70 years (mean 46.6). All patients underwent surgery in a full lateral position. Eight specimens were morcellated for removal and 6 were removed intact; 4 using a hand assist device and two by extending one of the port incisions. In 10 patients, total laparoscopic splenectomy was completed; four patients required use of a hand assist device due to difficulty with the operation. Mean spleen weight was 127 gms; spleen weight for ITP specimens was 90 gms; for non ITP diagnosis mean weight was 230 gms. Accessory spleens were identified and excised in two patients. Mean operative time for all patients was 137 minutes. Mean operative blood loss was 202 ml; no patients were transfused as a result of perioperative bleeding. Time to start diet was from 1-2 days and length of stay was 2.9 days. Two patients had post op fevers requiring prolonged length of stay. There were two readmission for deep venous thrombosis, and one for brain toxoplasmosis six weeks post op. Two ITP patients older than 40 years relapsed during the first year.

CONCLUSIONS

Laparoscopic splenectomy can be safely performed using the lateral approach with a high success rate, low rate of blood loss and a low rate of perioperative complications. Laparoscopic splenectomy should be offered to all patients undergoing surgery for ITP. Use of hand assist devices can facilitate surgery for larger spleens and avoid need of conversion to open surgery. Accessory spleens can be adequately identified and excised using laparoscopic splenectomy. Hematologic response in ITP is adequate with laparoscopic splenectomy.