Hand-assisted laparoscopic splenectomy for splenic tumors

The feasibility of hand-assisted laparoscopic splenectomy (HALS) for splenic tumors including benign or malignant neoplasms and the associated clinical outcome of the patients remain unclear.

A total of 10 patients with splenic tumors undergoing HALS were retrospectively analyzed in this study. The intraoperative course, postoperative course, and postoperative recovery were evaluated.

Ten patients with splenic tumors consisted of 5 with benign tumors and 5 with malignant tumors. HALS was not converted to an open splenectomy in any of the patients. Mean operative time was 170 min (range 100-310 min). Mean estimated blood loss was 105 g (range 10-900 g). Mean splenic size and splenic weight was 13 cm and 478 g, respectively. Splenomegaly based on size or weight occurred in 50% of the patients. There were no intra- or postoperative complications. Postoperative chemotherapy was given to 4 patients with malignant tumors including metastatic carcinomas and malignant lymphomas. All the patients were alive at a mean follow-up of 26 months, ranging from 15 to 43 months after surgery. There was no port-site recurrence after surgery in our study. Mean time to first flatus, mean time to first walking, mean time to resumption of oral intake, mean length of hospital stay, and mean duration of epidural analgesia were 1.8, 1, 1.5, 10.8 and 3.1 days, respectively. The results were equal in terms of intra- and postoperative course to those seen with a standard laparoscopic splenectomy for 13 patients with idiopathic thrombocytopenic purpura.

HALS may be a good indication for malignant tumors as well as benign tumors of the spleen.