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Guidelines for the performance of minimally invasive splenectomy
Tammy L Kindel1, Rebecca C Dirks2, Amelia T Collings2
1Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA.
Background:
Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical and peri-operative approaches to MIS is unclear.
Objective:
To develop evidence-based guidelines that support clinicians, patients, and others in decisions on the peri-operative performance of MIS.
Methods:
A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) including methodologists used the Grading of Recommendations Assessment, Development and Evaluation approach to grade the certainty of evidence and formulate recommendations.
Results:
Informed by a systematic review of the evidence, the panel agreed on eight recommendations for the peri-operative performance of MIS for adults and children in elective situations addressing six key questions.
Conclusions:
Conditional recommendations were made in favor of lateral positioning for non-hematologic disease, intra-operative platelet administration for patients with idiopathic thrombocytopenic purpura instead of preoperative administration, and the use of mechanical devices to control the splenic hilum. Further, a conditional recommendation was made against routine intra-operative drain placement.
Insights
Minimally invasive splenectomy (MIS) guidelines offer evidence-based recommendations for spleen surgery. These guidelines focus on specific techniques and peri-operative care to improve patient outcomes in MIS procedures.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Minimally invasive splenectomy (MIS) is preferred over open surgery for spleen diseases.
- While MIS offers benefits like reduced morbidity, optimal technical and peri-operative strategies require clarification.
Purpose of the Study:
- To establish evidence-based guidelines for the peri-operative management of MIS.
- To support clinicians and patients in making informed decisions regarding MIS.
Main Methods:
- A SAGES guidelines committee utilized the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
- A systematic review of evidence informed the development of recommendations.
Main Results:
- Eight recommendations were formulated for elective MIS in adults and children.
- Key areas addressed include patient positioning, splenic hilum control, and drain placement.
Conclusions:
- Conditional recommendations favor lateral positioning for non-hematologic spleen disease.
- Intra-operative platelet administration is recommended for idiopathic thrombocytopenic purpura over pre-operative administration.
- Routine intra-operative drain placement is not recommended.
