Laparoscopic splenectomy for malignant diseases

A variety of malignant diseases involving the spleen, both primary and metastatic, may require splenectomy for diagnosis or therapeutic reasons. The role of minimally invasive surgery in the management of malignant diseases involving the spleen is not well defined because of a lack of reported experience with laparoscopic splenectomy in this group. A reluctance to perform laparoscopic splenectomy in these patients may be explained by the technical and oncological challenges that often accompany malignant splenic diseases such as splenomegaly, perisplenitis, hilar lymphadenopathy, and fear of splenic disruption and tumor spillage. In our experience, the adoption of a lateral technique and the use of hand-assisted devices has allowed for the successful completion of laparoscopic splenectomy for malignant hematologic diseases including spleens up to 28 cm in length and greater than 3 kg morcellated weight. Laparoscopic splenectomy reliably alleviates the symptoms related to splenomegaly and reverses the hematologic abnormalities of hypersplenism. Although laparoscopic splenectomy for malignant diseases is feasible, the role of minimally invasive surgery in the staging of Hodgkin's lymphoma remains undetermined.