Unresolved issues in laparoscopic splenectomy

Katkhouda, Namir; Waldrep, Donald J.; Feinstein, Donald I.; Soliman, Hesham; Stain, Steven C.; Ortega, Adrián E.; Mouïel, J

doi:10.1016/s0002-9610(96)00243-7

Cited by 52 publications

(29 citation statements)

References 12 publications

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“…In the past few years several reports in literature have demonstrated its feasibility, safety, and efficacy, showing some advantages compared to open splenectomy, such as low postoperative pain, short hospital stay, and prompt return to daily activities [3,7,21,27]. Actually conversion rates are assessed between 2% to 10% in major series [20,25] and splenomegaly or uncontrolled bleeding from splenic hilum [12,24] are the main causes of conversion. The approach to hilar vessels is sometime cumbersome because of vascular hazard, especially when the tail of the pancreas is firmly adhered to vascular pedicles or mail branches divided far away from the spleen, and dissection without splenic tractions is recommended to avoid incidental hemorrhage, difficult to treat during laparoscopy.…”

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confidence: 99%

Laparoscopic splenectomy using ligasure

et al. 2002

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Laparoscopic splenectomy using ligasure

et al. 2002

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“…Preoperative assessment of splenic size by CT scan does not contribute to prediction of the risk of conversion to OS [10] and the efficacy of abdominal CT in detecting accessory spleens was only 25-28% [11]. However, US examination is essential in hereditary spherocytosis to detect gallstones.…”

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confidence: 99%

Laparoscopic Splenectomy for Hematological Disorders

Khoursheed

Alsayegh²,

Al-Bader³

et al. 2004

Med Princ Pract

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Objectives: The aim of this prospective study was to evaluate the safety and feasibility of laparoscopic splenectomy (LS) in patients with hematological disorders of the spleen. Subjects and Methods: Between 1999 and 2001, 15 patients (11 female and 4 male), with a mean age of 30 years, underwent LS after preoperative evaluation. If difficulties were encountered in LS, one trocar site incision was enlarged to 7–8 cm to engage the left hand for hand-assisted laparoscopic splenectomy (HALS) and the procedure was completed. Various parameters were reported, including spleen size as assessed by ultrasound scan, postoperative mortality and morbidity rates, accessory spleen removal, conversion rate, operative times and length of hospital stay. LS was successfully completed in 9 patients (60%) and HALS was performed in 4 patients (26.6%). Two patients required conversion to open splenectomy. Results: The mean operative time was 209 min and the mean hospital stay was 8.1 days. The hospital stay was significantly longer among HALS patients than LS patients. The mean age of patients and splenic size were associated with a significantly higher conversion rate. No deaths were attributed to the procedure. Complications occurred in 2 of 15 patients. Accessory spleens were identified in 2 patients. Conclusions: LS is both a safe and feasible procedure, but it requires great technical care to avoid serious complications.

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“…Another much-debated point concerns the search for and management of accessory spleens [9,10,15], This condition is present in 25% of cases and can cause recurrence of the hemtological disease after the splenectomy. Several studies have shown that a laparoscopy does not allow the complete detection of accessory spleens [11].…”

Section: Discussionmentioning

confidence: 99%

“…To deal with the risk of splenosis, great care must be taken during the dissection to avoid capsule breakage and consequent spillage of the splenic tissue, which could lead to secondary implantation within the abdominal cavity [2,8,17]. To reduce the risk of splenosis, the use of an automatic morcellator during the extraction phase should be avoided, and the fragmentation of the spleen into the endobag should be done using fingers or an atraumatic forceps [8,9].…”

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confidence: 99%

Technical standardization of laparoscopic splenectomy

et al. 2002

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We believe that the laparoscopic approach is a valid alternative to open splenectomy, but mastery of some of the technical details of this procedure could greatly help avoid its complications. On the basis of our experience, it seems that the lateral approach should be considered the position of choice because it provides exposure and easier dissection of the splenic hilar structures. We also found that a 30 degrees scope and an ultrasonic dissector allowed for perfect vision and optimal hemostasis during the procedure. At the end of procedure, the spleen should be fragmented and then extracted using an extraction bag.

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Unresolved issues in laparoscopic splenectomy

Cited by 52 publications

References 12 publications

Laparoscopic splenectomy using ligasure

Laparoscopic splenectomy using ligasure

Laparoscopic Splenectomy for Hematological Disorders

Technical standardization of laparoscopic splenectomy

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