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The lateral approach to laparoscopic splenectomy

A Park¹, M Gagner, A Pomp

¹Department of Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.

American Journal of Surgery

|February 1, 1997

Summary

The 4-trocar lateral approach for laparoscopic splenectomy offers superior exposure and easier dissection. This technique is a preferred method for laparoscopic splenectomy across various patient body types and spleen sizes.

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Area of Science:

Minimally Invasive Surgery
Surgical Techniques
Gastrointestinal Surgery

Background:

Laparoscopic splenectomy offers advantages over open surgery, including shorter hospital stays and faster return to work.
The anterior 5-trocar approach has been utilized.
A novel 4-trocar lateral approach was developed and is presented here.

Purpose of the Study:

To evaluate the efficacy and safety of a newly developed 4-trocar lateral approach for laparoscopic splenectomy.
To compare the exposure and dissection ease with previous methods.

Main Methods:

Twenty-two patients underwent laparoscopic splenectomy using the 4-trocar lateral approach.
Patients were positioned in the right lateral decubitus position.
A 10-mm trocar was placed in the left subcostal region, two in the flank, and a 5-mm trocar dorsally, utilizing a 30-degree laparoscope.

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Main Results:

The average operating room time was 169 minutes, with an average spleen weight of 513 grams.
Postoperative hospital stays averaged 5.4 days (median 3 days).
One conversion to laparotomy was necessary; there were no deaths, abscesses, pancreatic injuries, or bleeding complications.

Conclusions:

The lateral approach provides superior exposure for dissecting splenic hilar structures.
This technique is demonstrated to be the approach of choice for laparoscopic splenectomy.
The method is effective across diverse patient habitus and spleen sizes.