title: Laparoscopic splenectomy for hematologic disorders: experience with the first fifty patients.
abstract: BACKGROUND
  Splenectomy is increasingly being performed by various minimal access surgical modalities for select hematologic disorders.
  
  
  METHODS
  A retrospective analysis was performed on the first 50 patients on whom laparoscopic splenectomy (LS) was attempted. The data studied included indications for surgery, patient demographics, intraoperative parameters, and patient outcomes. A total laparoscopic approach (TLS) was employed in 38 patients and a hand-assisted technique (HALS) was used in 12 patients with massive splenomegaly. Eight patients had concomitant surgical procedures: 7 patients underwent laparoscopic cholecystectomy and 1 patient received a kidney transplant. The most common indications for LS were idiopathic thrombocytopenic purpura (ITP) (50%) and hereditary spherocytosis (24%).
  
  
  RESULTS
  LS was successfully completed in 48 patients (96%). Thirty-four patients (68%) required perioperative blood or platelet transfusions. The mean spleen diameter was 17.1 cm (range, 11.2-28.4 cm) on imaging study and mean intact splenic weight was 1019 gm. The mean operative time was 188 minutes (range, 90-340 minutes) in the TLS group and 171 minutes (range, 120-240 minutes) in the HALS group. The mean intraoperative blood loss was 306 mL (range, 40-640 mL) in the TLS group and 163 mL (range, 100-300 mL) in the HALS group. The mean postoperative hospital stay was 3.2 days (range, 2-5 days).
  
  
  CONCLUSIONS
  TLS is safe and feasible in patients with nonpalpable spleens. A concomitant laparoscopic procedure for treating coexisting abdominal pathology may be performed without additional morbidity. The HALS technique may be preferable in patients with splenomegaly (palpable spleens), as it appears to offer intraoperative advantages for retraction, dissection, hemostasis, and organ retrieval.
authors.affiliation: Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India. chowbey1@vsnl.com
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Chowbey
authors.forename: Amit
authors.initials: A
authors.lastname: Goel
authors.forename: Rashmi
authors.initials: R
authors.lastname: Panse
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khullar
authors.forename: Vandana
authors.initials: V
authors.lastname: Soni
authors.forename: Manish
authors.initials: M
authors.lastname: Baijal
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002763:Cholecystectomy; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D017713:Platelet Transfusion; D011696:Purpura, Thrombocytopenic / Q000601:surgery; D012189:Retrospective Studies; D013103:Spherocytosis, Hereditary / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome