A ten-year, single institution experience with laparoscopic splenectomy.
OBJECTIVE
Laparoscopic splenectomy (LS) is now widely performed and is considered the standard of care for the treatment of certain diseases of the spleen. Although multiple studies have documented the safety and feasibility of laparoscopic splenectomy, little long-term data are available. We present a 10-year, single institution experience with laparoscopic splenectomy to determine trends in procedural outcome data.


METHODS
Laparoscopic splenectomy was performed in 109 consecutive, unselected patients with benign or malignant hematological diseases from March 1992 to November 2001. A prospective, longitudinal database, medical record review, and patient interviews were used for data acquisition. During the last 10-years, the annual number of laparoscopic splenectomy was relatively constant. Therefore, patients were divided into 2 cohorts, comparing the first 55 consecutive patients (Group I) with the subsequent 54 patients (Group II) who underwent LS. Data were analyzed using the unpaired Student t test, with values of P < 0.05 considered significant.


RESULTS
Mean patient age was 39 years (range, 6 to 79) in Group I and 45 years (range, 13 to 77) in Group II. Total operative time was 151 minutes in Group I and 159 minutes in Group II (NS), estimated blood loss averaged 544 mm in Group I and 308mm in Group II (P = 0.015). The mean specimen weight of the spleen was 288 g in Group I and 512 g in Group II (P = 0.03). Morbidity occurred in 7 of the first 55 patients (13%) and 5 of the next 54 patients (9%). Additionally, 7 conversions to an open operation were necessary in Group I (13%) versus only 1 conversion in Group II (2%).


CONCLUSIONS
A decade of experience with LS shows that it can be performed safely for a wide variety of indications. Over the last 10 years, the average spleen size has increased, yet a significant reduction in blood loss and conversion rate has been achieved.
Section of Surgical Endoscopy and Laparoscopy, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA. robert.bell@yale.edu
Robert L
RL
Bell
Kate E
KE
Reinhardt
Eugene
E
Cho
John L
JL
Flowers
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery