engleski

Laparoscopic splenectomy: Initial single surgeon experience

Introduction: Laparoscopic splenectomy is an example of the recent continued advancement in laparoscopic surgery as techniques are adapted for procedures previously done only via a laparotomy. Spleen becomes one of the most common solid organs operated by laparoscopic approach. Here we present our initial experience with laparoscopic splenectomy performed by single surgeon due to different splenic disorders. Methods: During 3 years (from 2003 to 2006) we performed 12 laparoscopic splenectomies, in 8 females and 4 males with median age 44.8 yrs (18-75). Preoperative diagnoses included various splenic pathologies ; 4 patients with NHL, 1 with CLL, 2 with large cyst, 3 with ITP, one with spherocythosis and one with immune haemolytic anemia. Splenomegaly was defined as a spleen diameter > 15 cm measured on ultrasound or CT scan. We performed 3 trocars technique (9 patients) and 4 trocars technique (3 patients) in a right semilateral position. Results: Ten of 12 patients had enlarged spleen. Mean splenic size was 18.6 cm x 10.7 cm, with the biggest spleen measured at 27 cm x 15 cm, assessed by ultrasonic examination and CT scan. Patients with haematologic malignancy tended to have larger spleens. Splenomegaly tended to increase challenge for hillar control, mobilization and manipulation in abdominal cavity. Splenic vessels were secured with vascular Endo-GIA (8 patients), clips (2 patients) and "LigaSure" vessel sealing instrument (2 patients). Mean operating time was 150 min. Removing the spleen from abdominal cavity was the most time consuming part of operation. A significant problem that we faced was the lack of an appropriate large endoscopic bags. In spite of that there were no conversions to open splenectomy and no intraoperative or postoperative complications as well as no major complications or sepsis at a mean follow-up of 60 days. Conclusion: We regard that our series contributes to supporting laparoscopic splenectomy as a safe and effective method for benign as well as malignant haematological disease. Although caution should be exercised with enlarged spleen, our small experience suggests that laparoscopic splenectomy can be done in majority of patients with moderate splenomegaly retaining some advantages of minimally invasive techniques.

Laparoscopic splenectomy

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