Hand-assisted laparoscopic splenectomy (HALS) in cases of splenomegaly: a comparison analysis with conventional laparoscopic splenectomy.
BACKGROUND
Laparoscopic splenectomy (LS) is considerably more difficult to perform when the spleen is enlarged. The new technique of hand-assisted designed technique aimed to assist laparoscopic surgery allows the surgeon to insert his or her hand into the abdomen while maintaining the pneumoperitoneum, thus recovering the tactile sensation lost in conventional laparoscopic surgery.


OBJECTIVE
In this study, we compared the immediate results of conventional LS and hand-assisted LS (HALS) in cases of splenomegaly.


METHODS
Between February 1993 and August 2001, 200 LS were attempted at two university hospitals. In 56 cases, splenomegaly (final spleen weight >700 g) was observed clinically or detected on radiological examination. We compared the first 36 patients operated on by conventional LS (group I) with the last consecutive 20 patients, who underwent HALS (group II). The study parameters were operative time, conversion rate, transfusion rate, morbidity and length of hospital stay.


RESULTS
The groups were comparable in terms of age (58 +/- 13 [ranges, l9-82] vs 58 +/- 16 years [range, 44-84] (ns), diagnosis, and spleen weight (1425 +/- 884 [range, 700-3400]) vs 1753 +/- 1124 g [range, 720-4500] (ns). HALS was associated with less morbidity (36% vs 10%) (ns), a shorter operative time (177 +/- 52 [range, 95-300]) vs 135 +/- 53 min [range, 85-270] (p <0.009), and a shorter hospital stay (6.3 +/- 3.3 [range, 3-14]) vs 4 +/- 1.2 [range, 2-7] days (p <0.05).


CONCLUSIONS
In cases of splenomegaly, HALS assisted laparoscopic surgery significantly facilitates the surgical maneuvers during LS while maintaining the advantages of a purely laparoscopic approach.
Targarona
E M
EM
Department of General and Digestive Surgery, Hospital of Sant Pau, Autonomous University of Barcelona, C/Padre Claret 167, 08025, Barcelona, Spain. Etargarona@hsp.santpau.es
Balague
C
C
Cerdán
G
G
Espert
J J
JJ
Lacy
A M
AM
Visa
J
J
Trias
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery*; D016896:Treatment Outcome