The lateral approach to laparoscopic splenectomy.
BACKGROUND
Laparoscopic splenectomy has been shown to result in shorter hospital stays and a quicker return to work than conventional splenectomy. Having tried the anterior 5 trocar approach, we developed a 4 trocar lateral approach and now present our experience with 22 cases.


METHODS
All patients were placed in the right lateral decubitus position. A 10-mm trocar was inserted in the left subcostal region, 2 in the flank, and a 5-mm trocar dorsally. A 30 degrees laparoscope was used. Splenectomy was performed for varying pathologies.


RESULTS
Operating room (OR) time averaged 169 minutes, spleen weight 513 grams, and postoperative (post-op) stays 5.4 days (median 3 days). One patient was converted to laparotomy. There were no deaths, post-op abscesses, pancreatic injuries, or bleeding complications.


CONCLUSIONS
The lateral approach affords superior exposure, allowing easier dissection of splenic hilar structures. Over varying patient habitus and spleen size it has been demonstrated to be the approach of choice for laparoscopic splenectomy.
Park
A
A
Department of Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
Gagner
M
M
Pomp
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011292:Premedication; D013156:Splenectomy / Q000379:methods*; D013924:Thrombophlebitis / Q000517:prevention & control; D013997:Time Factors
D006493:Heparin