Trends in laparoscopic splenectomy for massive splenomegaly
ABSTRACT During the past 10 years, expertise with minimally invasive techniques has grown, leading to an increase in successful laparoscopic splenectomy (LS) even in the setting of massive and supramassive spleens.
Retrospective series of patients who underwent splenectomy from November 1, 1995, to August 31, 2005.
Academic tertiary care center.
Adult patients who underwent elective splenectomy as their primary procedure (n = 111).
Demographics, spleen size and weight, conversion from LS to open splenectomy, postoperative length of stay, and perioperative complications and mortality. Massive splenomegaly was defined as the spleen having a craniocaudal length greater than 17 cm or weight more than 600 g, and supramassive splenomegaly was defined as the spleen having a craniocaudal length greater than 22 cm or weight more than 1600 g.
Eighty-five (77%) of the 111 patients underwent LS. Of these 85 patients, 25 (29%) had massive or supramassive spleens. These accounted for 40% of LSs performed in 2004 and 50% in 2005. Despite this increase in giant spleens, the conversion rate for massive or supramassive spleens has declined from 33% prior to 1999 to 0% in 2004 and 2005. Since January 2004 at our institution, all of the massive or supramassive spleens have been removed with a laparoscopic approach. Patients with massive or supramassive spleens who underwent LS had no reoperations for bleeding or deaths and had a significantly shorter postoperative length of stay (mean postoperative length of stay, 3.8 days for patients who underwent LS vs 9.0 days for patients who underwent open splenectomy; P<.001).
Despite conflicting reports regarding the safety of LS for massive splenomegaly, our data indicate that with increasing institutional experience, the laparoscopic approach is safe, shortens the length of stay, and improves mortality.
- SourceAvailable from: Bruno Suchaut[Show abstract] [Hide abstract]
ABSTRACT: Cette étude vise trois objectifs : réaliser un état des lieux des processus de réformes curriculaires en éducation de base en Afrique pour identifier les problèmes rencontrés, les résultats positifs et les "bonnes pratiques", aider les responsables des systèmes éducatifs à prendre des mesures pertinentes et accompagner les réformes et enfin aider les bailleurs de fonds à mieux comprendre les effets de leur aide et à mieux cibler les projets de réforme en termes de coût et d'efficacité à tous les niveaux des systèmes éducatifs impliqués.
- [Show abstract] [Hide abstract]
ABSTRACT: Laparoscopic splenectomy has been demonstrated as an effective and safe treatment for benign and malignant haematological disorders requiring spleen removal, as well as for splenic masses. However, many procedural and outcome factors are under continuous evaluation and others remain controversial. The procedure requires expertise in laparoscopic surgical techniques and meticulous dissection of the spleen. Management should include preoperative radiologic assessment to measure splenic volume, preoperative vaccination and heparin administration. The cost of the operation per se is higher with the laparoscopic method, but the overall cost is the same or reduced compared to the open procedure. Laparoscopic splenectomy incurs longer operation time, depending on the surgeon’s experience, but results in shorter hospitalization, earlier return to full activity, decreased postoperative pain and a better cosmetic result. Additionally, it is associated with lower complication rates. The increasing experience of surgeons and the improvement in laparoscopic surgical equipment have lead to an increasing acceptance of laparoscopy as the preferred approach for splenectomy, even in patients with massive splenomegaly.Hellēnikē cheirourgikē. Acta chirurgica Hellenica 06/2012; 84(3). DOI:10.1007/s13126-012-0020-2
- [Show abstract] [Hide abstract]
ABSTRACT: LAPAROSCOPIC SPLENECTOMY – SURGICAL TECHNIQUE (Abstract): Laparoscopic splenectomy (LS) is the second level of skill for a surgeon. The aim of this paper is to present the technique and the tricks for a succesfull splenectomy. There are also presented some datas of history of spleen surgery and surgical anatomy. Indications of laparoscopic splenectomy are the same as in the open technique. The standard operative technique is described. I also present different laparoscopic techniques so as trocars approach, dissection, divided of the spleen vessels by Ligasure or staplers, hand assited technique etc. The postoperative course and follow-up are also described. Conclusion: Laparoscopic splenectomy is a feasible technique. An adequate training in laparoscopic surgery and modern technologies are necessary to perform this operation. LS is the gold standard treatment for idiopathic thrombocytopenic purpura.