Laparoscopic splenectomy: an evolving technique. A comparison between anterior and lateral approaches

Area of Science:

• Minimally invasive surgery
• Surgical techniques
• Gastrointestinal surgery

Background:

• Laparoscopic cholecystectomy success has driven broader laparoscopic applications.
• Laparoscopic splenectomy (LS) presents challenges in mobilizing and manipulating solid organs.
• A lateral approach is explored as an alternative to the anterior approach for improved LS facilitation.

Purpose of the Study:

• To compare the outcomes of laparoscopic splenectomy (LS) using anterior versus lateral approaches.
• To evaluate the technical feasibility and patient benefits of the lateral approach for LS.

Main Methods:

• A comparative study of 27 laparoscopic splenectomies (LS) between February 1993 and May 1995.
• Group I (Ant-LS, n=10) utilized an anterior approach; Group II (Lat-SL, n=17) used a lateral approach.
• Indications included idiopathic thrombocytopenic purpura, spherocytosis, AIDS-related thrombocytopenia, autoimmune anemia, and leucopenia.

Main Results:

• LS completion rates were 80% for the anterior approach and 100% for the lateral approach.
• The lateral approach group showed significantly lower operative times (159 vs. 236 min), fewer trocars (4 vs. 4.5), reduced transfusion requirements (17% vs. 60%), and shorter hospital stays (4 vs. 6.5 days).
• Statistical significance (p < 0.05) was observed for all compared parameters.

Conclusions:

• The lateral approach significantly facilitates laparoscopic splenectomy (LS) compared to the anterior approach.
• This technique offers improved efficiency and patient recovery in LS procedures.