title: Hand-assisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly.
abstract: OBJECTIVE
  Laparoscopic splenectomy (LS) is the procedure of choice for elective splenectomy. Splenomegaly may preclude safe mobilization and hilar control using conventional laparoscopic techniques. Hand-assisted LS (HALS) may offer the same benefits of minimally invasive surgery for splenomegaly while allowing safe manipulation and splenic dissection.
  
  
  METHODS
  A retrospective review of patients with splenomegaly undergoing conventional LS or HALS was performed.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  Hand-assisted LS was performed at the start of the operation for patients with splenomegaly; splenomegaly was determined by palpation of the splenic tip extending to the midline or the iliac crest, or by a craniocaudal splenic length of greater than 22 cm. Splenomegaly was defined as a splenic weight of greater than 700 g after morcellation.
  
  
  METHODS
  Patient demographic characteristics, operative indications, splenic weight after morcellation, morbidity, mortality, and clinical outcomes were evaluated.
  
  
  RESULTS
  Forty-five patients with splenomegaly were identified: 31 underwent standard LS and 14 underwent HALS. The HALS group had significantly larger spleens than the conventional LS group (mean weight, 1516 vs 1031 g; P =.02). Mean operative time (177 vs 186 minutes; P =.89), estimated blood loss (602 vs 376 mL; P =.17), and length of hospital stay (5.4 vs 4.2 days; P =.24) and complication rates (5 [36%] of 14 vs 5 [16%] of 31; P =.70) were similar between the HALS and the standard LS groups. No perioperative mortality occurred.
  
  
  CONCLUSIONS
  Hand-assisted LS is a safe and efficacious procedure for these extremely difficult cases. Hand-assisted LS provides the benefits of a minimally invasive approach in cases of splenomegaly.
authors.affiliation: Department of General Surgery, Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, 9500 Euclid Ave, Bldg A-80, Cleveland, OH 44195, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rosen
authors.forename: Fred
authors.initials: F
authors.lastname: Brody
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ponsky
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery*; D016896:Treatment Outcome