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Mini-laparoscopic splenectomy
C L Backus1, A E Park, B D Matthews
1Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
Background And Purpose:
Since the introduction of mini-laparoscopic instruments (2- to 3-mm diameter), their utility and safety have been questioned. Their application in cholecystectomy has recently been documented. This study determined the adequacy and safety of these minimally invasive instruments in laparoscopic splenectomy.
Methods:
Retrospective review of all 16 mini-laparoscopic splenectomies performed by the authors was carried out. Diagnoses included immune thrombocytopenia (5), spherocytosis (6), and beta-thalassemia, sickle-cell disease, splenic mass, cyst, and splenomegaly in 1 case each. The average age of the patients was 20.1 years (range 4-70 years); seven patients were adults. Ten of the patients were female. The patients' body mass index ranged from 17 to 25 kg/m2. Splenomegaly (at least two times normal size: 100-200 g for children, 400-600 g for adults) was present in each case. A three-trocar technique was used in 15 patients, and a fourth trocar was required in only one case.
Results:
The average operative time and blood loss were 114 minutes (range 60-195 minutes) and 44 mL (range 10-150 mL), respectively. There were no intraoperative complications, and no patient required transfusion. Conversion to standard laparoscopy or laparotomy did not occur. The mean hospital stay was 1.4 days (range 1-2 days). With an average 20-month follow-up, no wound, septic, or other complications have been identified. All patients or their families (in the case of children) graded the cosmetic outcome as excellent.
Conclusion:
The use of mini-laparoscopic instruments for splenectomy is safe and effective in children and adults with a normal body mass index, even in the case of splenomegaly. Operative times are reasonable, and hospital stays are brief. The postoperative cosmetic appearance is excellent.
Insights
Mini-laparoscopic instruments (2- to 3-mm diameter) are safe and effective for laparoscopic splenectomy in children and adults. This minimally invasive approach offers reasonable operative times, brief hospital stays, and excellent cosmetic outcomes, even with splenomegaly.
Area of Science:
- Minimally Invasive Surgery
- Surgical Technology
- Gastrointestinal Surgery
Background:
- Mini-laparoscopic instruments (2- to 3-mm diameter) are increasingly used in surgery.
- Their safety and efficacy, particularly in laparoscopic splenectomy, require thorough evaluation.
- Previous studies have documented their use in cholecystectomy.
Purpose of the Study:
- To determine the adequacy and safety of mini-laparoscopic instruments in laparoscopic splenectomy.
- To assess the outcomes of using these instruments in a diverse patient population.
- To evaluate the feasibility of mini-laparoscopic splenectomy in cases of splenomegaly.
Main Methods:
- Retrospective review of 16 mini-laparoscopic splenectomies.
- Patient diagnoses included immune thrombocytopenia, spherocytosis, beta-thalassemia, sickle-cell disease, splenic mass, cyst, and splenomegaly.
- A three-trocar technique was predominantly used, with a fourth trocar needed in one case.
Main Results:
- Average operative time was 114 minutes, with an average blood loss of 44 mL.
- No intraoperative complications or need for transfusion occurred; no conversions to open surgery were necessary.
- Mean hospital stay was 1.4 days, with excellent cosmetic outcomes and no reported complications at 20-month follow-up.
Conclusions:
- Mini-laparoscopic instruments are safe and effective for splenectomy in pediatric and adult patients with normal body mass index.
- The procedure is suitable even in the presence of splenomegaly.
- The technique results in reasonable operative times, short hospital stays, and superior cosmetic results.