Hand-assisted Laparoscopic Splenectomy Advantages Over Complete Laparoscopic Splenectomy For Splenomegaly

Abstract

Background: Laparoscopic splenectomy (LS) is generally applied for splenectomy, However, it also brings some technical challenges, especially for splenomegaly. Hand-assisted laparoscopic splenectomy (HALS) can help to overcome these drawbacks while maintaining the superiority of LS. This study was aimed to evaluate the efficacy and advantage of HALS for splenomegaly.Materials and Methods: Between January 2014 and November 2017, 91 patients with splenomegaly in 2 surgical centers were randomly assigned to either HALS (n = 45) or LS (n = 46). The patients' characteristics, intraoperative details, and the postoperative outcomes in both groups were compared.Results: Baseline features (sex, age, main diameter, Child-Pugh grade) of both groups had no significant difference (P < 0.05). Compared with LS group, the HALS group operation time (141 ± 46 vs. 172 ± 43 min; P = 0.001) was shorter, intraoperative blood loss [215 (122.332) vs. 230 (130.740) mL; P = 0.026], hospital expenses (5.5 ± 1.5 vs. 6.4 ± 2.4 WanRMB; P = 0.022), and conversion rate (1/45 vs. 9/46; P = 0.015) were lower. However, there was no significant difference for hospital stay (6.4 ± 2.8 vs. 6.7 ± 3.0 d; P = 0.662) and complications (15/45 vs. 12/46; P = 0.893) between the 2 groups. In addition, there were no significant differences in postoperative white blood cell (10.6 ± 2.9 vs. 10.9 ± 3.5; P = 0.747), AST [61 (47.94) vs. 57 (37.86) U/L; P = 0.513], and ALT [68 (54.120) vs. 55 (36.99) U/L; P = 0.302] levels.Conclusions: HALS can maximize the benefits for patients, while maintaining the advantages of LS and open splenectomy. It is the ideal surgical treatment for splenomegaly.

Complications and outcomes associated with laparoscopic-assisted splenectomy in dogs

“…15,16 This is especially beneficial in cases of splenomegaly, where total laparoscopic manipulation is challenging and frequently resulted in conversion to open laparotomy. 17 HALS approaches for human splenectomy have since been shown to have reduced conversion rates relative to conventional laparoscopic splenectomy 18,19 and is the preferred approach in cases of splenomegaly. 19 Similar findings were supported in this study in dogs, where LAS was successfully performed to remove spleens with splenic masses up to 15 cm in diameter, or 55.2 cm 3 /kg by volume in dogs ranging from 4 to 55 kg.…”

Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta‐analysis

“…The LS versus OS group included 12 studies [5,8,[12][13][14][15][16][17][18][19][20][21] (one ambidirectional cohort, five prospective cohorts, and six retrospective cohorts, with a total of 652 patients). The HALS versus OS [22,23] group included two studies (one retrospective cohort and one prospective randomized control trial with a total of 398 patients), and the LS versus HALS [8,[24][25][26][27] group included five studies (four retrospective cohorts and one prospective cohort, with a total of 306 patients). The RS versus LS [28] group included only one retrospective cohort.…”

Application of Real‐Time Augmented Reality Laparoscopic Navigation in Splenectomy for Massive Splenomegaly

“…All patients underwent preoperative CT scans, and their splenic volume was measured accurately. According to guidelines of the European Association for Endoscopic Surgery (EAES), massive splenomegaly is defined as a maximum splenic diameter exceeding 20 cm at preoperative imaging [15, 16].…”