Minimal-access splenectomy: a viable alternative to laparoscopic splenectomy in massive splenomegaly.
BACKGROUND
Laparoscopic splenectomy of normal-sized spleens or in moderate splenomegaly is performed with increasing frequency. By using a modification of the open laparotomy, minimal-access splenectomy is an attractive alternative in severe splenomegaly.


METHODS
Between September 2002 and October 2003, 9 patients (mean age, 58.8 years; range, 41 to 72) with severe splenomegaly (mean length, 27.9 cm; range, 23 to 32) underwent minimal-access splenectomy. Indications for splenectomy were non-Hodgkin's lymphoma in 5 cases and idiopathic myelofibrosis in 4.


RESULTS
Minimal-access splenectomy was successfully completed in all patients. Mean operative time was 124 minutes (range, 75 to 165). Postoperative complications occurred in 2 cases; one perioperative death occurred in a patient with idiopathic myelofibrosis as a consequence of a secondary blast crisis. Median postoperative hospital stay was 9.1 days (range, 6 to 15).


CONCLUSIONS
Minimal-access splenectomy seems to be a viable alternative to laparoscopic splenectomy in cases of severe splenomegaly. It combines the advantages of hand assistance like shorter operative times and increased safety of the procedure to the classical benefits of minimally invasive surgery.
Casaccia
Marco
M
Advanced Laparoscopic Unit, Department of General and Transplant Surgery, St Martino Hospital, University of Genoa, Italy. Marco.Casaccia@unige.it
Torelli
Paolo
P
Cavaliere
Davide
D
Santori
Gregorio
G
Panaro
Fabrizio
F
Valente
Umberto
U
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly