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Pediatric laparoscopic splenectomy using the lateral approach
P G Fitzgerald1, J C Langer, B H Cameron
1Children's Hospital, Chedoke-McMaster, 1200 Main St. W., Hamilton, ON L8N 325, Canada.
Surgical Endoscopy
|August 1, 1996
Summary
This study shows a four-port lateral approach for laparoscopic splenectomy in children is safe and effective. It leads to reduced pain, shorter hospital stays, and faster recovery for pediatric patients undergoing spleen removal.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic splenectomy offers benefits like reduced pain and shorter hospital stays in children.
- The four-port lateral approach is a specific technique for laparoscopic splenectomy.
Purpose of the Study:
- To evaluate the safety and efficacy of a four-port lateral approach for laparoscopic splenectomy in pediatric patients.
- To describe the surgical technique and patient outcomes associated with this approach.
Main Methods:
- Eighteen pediatric patients underwent laparoscopic splenectomy using a four-port lateral decubitus position.
- The technique involved specific port placement, splenic flexure mobilization, and use of an endo-GIA for vessel control.
- Spleens were bagged, morcellated, and extracted, with accessory spleens removed in some cases.
Main Results:
- The median operative time was 160 minutes with a median blood loss of 105 ml.
- The median hospital stay was 2 days, and return to full activities was 8 days.
- One transient complication of pancreatitis with pleural effusion occurred; three patients needed port site extension for large spleen removal.
Conclusions:
- The four-port lateral approach provides excellent visualization of splenic vessels, pancreas, and accessory spleens.
- This method is safe, reliable, and the preferred approach for pediatric laparoscopic splenectomy in this series.
- The technique facilitates reduced postoperative pain, hospital stay, and accelerated return to activities.