Experience with seven cases of massive splenomegaly.
BACKGROUND
Laparoscopic excision of extremely large spleens has been variously reported, but the usual consensus in the literature is that any patient with a spleen anything over 3000 g is simply not a proper candidate for laparoscopy. This report details our experience with 7 patients (out of 95 operated on) with spleens ranging in size up to 4800 g.


METHODS
Our operative procedure involved 3 or 4 trocars placed along a virtually semicircular line centered over the splenic hilum. Splenic attachments were excised with the ultrasonic dissector, and the hilum divided with a stapler. Due to the size of the spleens, Pfannenstiel's incisions were utilized for hand-port placement in the extraction of the specimen.


RESULTS
Surgery was successful in all 7 cases, and required no conversion to an open procedure. The average splenic weight was 3450 g (range, 3000-4800 g). Mean operative time was 168 minutes (range, 127-250 minutes).


CONCLUSIONS
Because of improved instrumentation (i.e., laparoscopic stapler and ultrasonic dissector) and refinement of technique, spleens very much larger than what was once considered practicable can now be excised laparoscopically with similarly low morbidity as compared with open splenectomy.
Choy
Charles
C
Department of Surgery, Staten Island University Hospital, New York, USA.
Cacchione
Robert
R
Moon
Victor
V
Ferzli
George
G
D000368:Aged; D016063:Blood Loss, Surgical; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery*