Three‐Dimensional CT Volumetry Predicts Outcome of Laparoscopic Splenectomy for Splenomegaly: Retrospective Clinical Study

Filicori, Filippo; Stock, Cameron; Schweitzer, Andrew D.; Keutgen, Xavier M.; LaGratta, Maria D.; Zarnegar, Rasa; Fahey, Thomas J.

doi:10.1007/s00268-012-1789-4

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…In presence of radiologically documented splenomegaly, some surgeons discourage laparoscopic splenectomy in favor to open surgery [15]. Others suggest a peri-operative splenic artery embolization to reduce the organ size and ease the laparoscopic splenectomy [16].…”

Section: Discussionmentioning

confidence: 99%

“…Seven patients, affected by spherocytosis (3), epidermoid cyst (2), idiopathic thrombocytopenic purpura (2) and thalassemia (1), underwent laparoscopic splenectomy at a median age of 10 years (range: 8-17). Median patients' weight was 32.5 kg (range: 25-71) and spleen size 15 cm (11)(12)(13)(14)(15)(16)(17)(18). In all the cases, upon removal of the camera, the retrieval bag was inserted thru the umbilicus under direct view, the spleen retrieved, morcellated, and removed.…”

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The Alexis® system for laparoscopic splenectomy in pediatric patients

et al. 2021

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The laparoscopic splenectomy in pediatric patients is performed worldwide but often the disproportion between size of patients and size of organs requires an extra laparotomic access for spleen removal. The aim of the present study was to evaluate the safety and effectiveness of the Alexis® system to retrieve the spleen without additional laparotomic access. The charts of all patients who underwent splenectomy at our center during the last 5 years were retrieved. In all the cases the Alexis® system was placed in the umbilicus, thru which a 10 mm camera was inserted. Three additional 5 mm standard trocars were inserted. Seven patients, affected by spherocytosis (3), epidermoid cyst (2), idiopathic thrombocytopenic purpura (2) and thalassemia (1), underwent laparoscopic splenectomy at a median age of 10 years (range: 8–17). Median patients’ weight was 32.5 kg (range: 25–71) and spleen size 15 cm (11–18). In all the cases, upon removal of the camera, the retrieval bag was inserted thru the umbilicus under direct view, the spleen retrieved, morcellated, and removed. No conversion nor enlargement of one of the ports nor an extra laparotomic access were required. The patients were discharged on the fifth post-operative day and the cosmetic results were excellent. Removal of the spleen can be safely performed without any additional laparotomy thru the Alexis® system placed in the umbilicus. This system is effective also in case of major patient/organ size disproportion and the final cosmetic aspect is excellent.

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The Alexis® system for laparoscopic splenectomy in pediatric patients

et al. 2021

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Are there any limits for laparoscopy in splenomegaly? Our experience

Santarelli¹,

Secco

Celi

et al. 2020

Updates Surg

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Assessing Splenomegaly

Linguraru¹,

Sandberg²,

Jones³

et al. 2013

Academic Radiology

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Rationale and Objectives To define systematic volumetric thresholds to identify and grade splenomegaly, and retrospectively evaluate the performance of radiologists to assess splenomegaly in computed tomography image data. Materials and Methods A clinical tool was developed to segment spleens from 172 contrast-enhanced clinical CT studies. There were 45 normal and 127 splenomegaly cases confirmed by radiological reports. Spleen volumes were compared to manual measurements using overlap/error. Volumetric thresholds for mild/massive splenomegaly were defined at 1/2.5 standard deviations above the average splenic volume of the healthy population. The thresholds were validated against consensus reports. The performance of radiologists in assessing splenomegaly was retrospectively evaluated. Results The automated segmentation of spleens was robust with volume overlap/error of 95.2/3.3%. There were no significant differences (p>0.2) between manual and automated segmentations for either normal/splenomegaly subgroups. Comparable correlations between interobserver and manual-automated measurements were found (R=0.99 for all). The average volume of normal spleens was 236.89±77.58 ml. For splenomegaly, average volume was 1004.75±644.27 ml. Volumetric thresholds of 314.47/430.84 ml were used to define mild/massive splenomegaly (+/−18.86 ml 95% CI). Radiologists disagreed in 23.25% (n=40) of the diagnosed cases. The area under the ROC curve of the volumetric criterion for splenomegaly detection was 0.96. Using the volumetric thresholds as the reference standard, the sensitivity of radiologists in detecting all/mild/massive splenomegaly was 95.0/66.6/99.0% at 78.0% specificity, respectively. Conclusion Thresholds for the identification and grading of splenomegaly from automatic volumetric spleen assessment were introduced. The volumetric thresholds match well with clinical interpretations for splenomegaly and may improve splenomegaly detection compared with splenic cephalocaudal height measurements or visual inspection commonly used in current clinical practice.

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Three‐Dimensional CT Volumetry Predicts Outcome of Laparoscopic Splenectomy for Splenomegaly: Retrospective Clinical Study

Cited by 6 publications

References 32 publications

The Alexis® system for laparoscopic splenectomy in pediatric patients

The Alexis® system for laparoscopic splenectomy in pediatric patients

Are there any limits for laparoscopy in splenomegaly? Our experience

Assessing Splenomegaly

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