title: Laparoscopic splenectomy in the management of benign and malignant hematologic diseases.
abstract: OBJECTIVE
  The use of laparoscopy to treat malignant hematological diseases is not completely accepted. Our aim was to analyze operative and postoperative results of laparoscopic splenectomy performed for benign versus malignant hematological disorders.
  
  
  METHODS
  Between 1994 and 2003, 76 consecutive patients underwent laparoscopic splenectomy. The first 38 cases were performed by using an anterior approach, whereas in the remaining 38 cases a semilateral position was used.
  
  
  RESULTS
  Baseline characteristics showed that patients with malignant diseases were significantly older (56.9 vs 32.6 years, P < 0.001). Seventy-two (94.7%) procedures were completed laparoscopically. Conversion was required in 4 cases (5.2%). Mean operative time was 138.5 minutes for benign and 151.0 minutes for malignant diseases, (P > 0.05, ns). The hand-assisted technique was used in 3 patients with massive splenomegaly. Pathologic features showed that spleen volume was higher in patients with malignant diseases (mean interpole diameter 18.1 cm vs 13.7 cm, P < 0.001). Massive splenomegaly (interpole diameter over 20 cm, weight over 1000 g) was present in 13 patients (17.1%); 9 had malignant diseases. Overall perioperative mortality was 1.3% and major postoperative complications occurred in 6 patients (7.8%). Postoperative splenoportal partial thrombosis was identified in 9.7% of patients.
  
  
  CONCLUSIONS
  Laparoscopic splenectomy is a well-accepted, less-invasive procedure for hematological disorders. Neoplastic diseases or splenomegaly, or both, do not seem to limit the indications for a minimally invasive approach after the learning curve.
authors.affiliation: Department of General Surgery Paride Stefanini, Policlinico Umberto I, University La Sapienza, Rome, Italy. gianfranco.silecchia@uniroma1.it
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
authors.forename: Cristian Eugeniu
authors.initials: CE
authors.lastname: Boru
authors.forename: Aldo
authors.initials: A
authors.lastname: Fantini
authors.forename: Luigi
authors.initials: L
authors.lastname: Raparelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pecchia
authors.forename: Paolo
authors.initials: P
authors.lastname: Fabiano
authors.forename: Nicola
authors.initials: N
authors.lastname: Basso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000379:methods*