Technical standardization of laparoscopic splenectomy

Abstract

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.

The Feasibility and Safety of Laparoscopic Splenectomy for Massive Splenomegaly: A Comparative Study

“…However, laparoscopic splenectomy (LS) is more challenging when performed in patients with splenomegaly. Technical difficulties associated with splenomegaly, such as well-developed collateral circulation and increased risks of bleeding, were considered limitations for LS [12]. Portal hypertension secondary to liver cirrhosis, the main cause of splenomegaly in China, is still a contraindication to LS in the clinical practice guidelines of the European Association for Endoscopic Surgery [6].…”

Outpatient laparoscopic splenectomy: patient safety and satisfaction

“…In the protocol for outpatient laparoscopic splenectomy, our wellestablished laparoscopic team performed all procedures by the transabdominal lateral flank approach [2,6]. Only three trocars-two 11-mm and one 12-mm-were used, an 11-mm in the umbilicus, an 11-mm epigastric, and finally the 12-mm in the left flank.…”

“…Outcome parameters such as postoperative pain and hospital stay, as well as convalescence, are significantly improved with the laparoscopic technique. Complication rates are also lower [2,6,16,23], given sufficient surgical training and education [15].…”

Impact of morbid obesity on outcome of laparoscopic splenectomy

“…The laparoscopic approach results in less morbidity, shorter hospital stays, and an earlier return to normal activity than the traditional open approach [6,8,9,14,15,19,29,40,43]. For extremely large spleens, a hand-assisted laparoscopic splenectomy (HALS) may be used to preserve the benefits of the minimally invasive approach [17,21,32].…”