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Hand-Assisted Laparoscopic Splenectomy vs Conventional Laparoscopic Splenectomy in Cases of Splenomegaly
Michael Rosen, MD;
Fred Brody, MD;
R. Matthew Walsh, MD;
Jeffrey Ponsky, MD
Arch Surg. 2002;137:1348-1352.
Hypothesis Laparoscopic splenectomy (LS) is the procedure of choice for elective splenectomy. Splenomegaly may preclude safe mobilization and hilar control using conventional laparoscopic techniques. Hand-assisted LS (HALS) may offer the same benefits of minimally invasive surgery for splenomegaly while allowing safe manipulation and splenic dissection.
Design A retrospective review of patients with splenomegaly undergoing conventional LS or HALS was performed.
Setting Tertiary care referral center.
Patients Hand-assisted LS was performed at the start of the operation for patients with splenomegaly; splenomegaly was determined by palpation of the splenic tip extending to the midline or the iliac crest, or by a craniocaudal splenic length of greater than 22 cm. Splenomegaly was defined as a splenic weight of greater than 700 g after morcellation.
Main Outcome Measures Patient demographic characteristics, operative indications, splenic weight after morcellation, morbidity, mortality, and clinical outcomes were evaluated.
Results Forty-five patients with splenomegaly were identified: 31 underwent standard LS and 14 underwent HALS. The HALS group had significantly larger spleens than the conventional LS group (mean weight, 1516 vs 1031 g; P = .02). Mean operative time (177 vs 186 minutes; P = .89), estimated blood loss (602 vs 376 mL; P = .17), and length of hospital stay (5.4 vs 4.2 days; P = .24) and complication rates (5 [36%] of 14 vs 5 [16%] of 31; P = .70) were similar between the HALS and the standard LS groups. No perioperative mortality occurred.
Conclusions Hand-assisted LS is a safe and efficacious procedure for these extremely difficult cases. Hand-assisted LS provides the benefits of a minimally invasive approach in cases of splenomegaly.
From the Department of General Surgery, Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Cleveland, Ohio.
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