Pediatric Surgery Unit, Federico II University Hospital, Naples, Italy.
Pediatric Surgery Unit, Santobono Pausilipon Children Hospital, Naples, Italy.
J Laparoendosc Adv Surg Tech A. 2022 Sep;32(9):1010-1015. doi: 10.1089/lap.2022.0038. Epub 2022 Jul 7.
This study aimed to review our 25-year experience with pediatric laparoscopic splenectomy (LS) and describe tips, tricks, and technical considerations. The records of 121 children, undergoing minimally invasive splenectomy in the last 25 years (1996-2021), were retrospectively reviewed. Median patient age was 10.2 years (range 7-17). The patients were grouped according to the period: G1 (1996-2005) included 31 patients undergoing open splenectomy using left subcostal minilaparotomy (G1a) and 28 receiving LS using supine position (G1b); G2 (2006-2021) included 62 patients undergoing LS using lateral decubitus. A five-trocar technique was adopted in G1b, with the spleen removed through a Pfannenstiel incision. In G2, we preferred to use lateral decubitus, 10-mm 30° optic, only four trocars, and sealing devices. In such cases, the spleen was placed in an endobag, finger-fragmented, and extracted through the umbilicus. Furthermore, indocyanine green (ICG) fluorescence was used in the last 4 G2 patients to clearly identify the vascular anatomy. The median operative time was 65 minutes in G1a, 125 in G1b, and 95 in G2. Complications occurred intraoperatively in 14 cases (11.5%): 5 bleedings during dissection (G1b), 4 endobag breakages during spleen removal (G2); 3 spleen capsule breakages during removal (G1a); and 2 instrumentation failures (G2). No conversions to open occurred. Median hospital stay was 6 days in G1a and 4 days in G1b and G2. LS is a standardized and effective procedure in children and is preferable to mini- or conventional open splenectomy. Our 25-year experience showed that major complications may occur even in expert hands, mainly during hilar dissection or spleen extraction. Technically, sealing devices and ICG fluorescence were helpful to perform a safer and faster procedure. We believe that lateral decubitus and 30° optic should be considered technical key points to provide excellent organ exposure and easier dissection of hilar structures.
本研究旨在回顾我们 25 年来小儿腹腔镜脾切除术（LS）的经验，并描述技巧、窍门和技术注意事项。回顾了过去 25 年（1996-2021 年）接受微创脾切除术的 121 名儿童的病历。中位患者年龄为 10.2 岁（范围 7-17 岁）。根据时间段将患者分组：G1（1996-2005 年）包括 31 例行左肋缘下小切口开腹脾切除术（G1a）和 28 例行仰卧位 LS（G1b）的患者；G2（2006-2021 年）包括 62 例行侧卧位 LS 的患者。G1b 采用五孔技术，脾脏通过脐部切口取出。在 G2 中，我们更倾向于使用侧卧位、10mm30° 光学镜、仅四个套管和密封装置。在这种情况下，将脾脏放入内置袋中，碎成碎片，通过脐部取出。此外，最后 4 名 G2 患者使用吲哚菁绿（ICG）荧光术清晰识别血管解剖结构。G1a 的中位手术时间为 65 分钟，G1b 为 125 分钟，G2 为 95 分钟。术中并发症 14 例（11.5%）：G1b 分离时 5 例出血，G2 脾脏取出时 4 例内置袋破裂，G1a 脾脏取出时 3 例包膜破裂，G2 仪器故障 2 例。无中转开腹。G1a 和 G1b 和 G2 的中位住院时间为 6 天。LS 是小儿标准化、有效术式，优于小切口或传统开腹脾切除术。我们 25 年的经验表明，即使在经验丰富的医生手中，主要在肝门解剖或脾脏取出过程中，也可能发生严重并发症。技术上，密封装置和 ICG 荧光术有助于进行更安全、更快的手术。我们认为，侧卧位和 30°光学镜应被视为提供良好器官暴露和更容易分离肝门结构的技术要点。
