Hand-assisted laparoscopic splenectomy for splenomegaly: a comparative study with conventional laparoscopic splenectomy.
BACKGROUND
Laparoscopic splenectomy (LS) has been considered as the standard approach to remove a normal-sized spleen, but it is facing technical challenges when applied to splenomegaly. Hand-assisted laparoscopic technique was designed to facilitate the performance of difficult laparoscopic procedure. This study was aimed to evaluate the efficacy and superiority of hand-assisted laparoscopic splenectomy (HALS) for splenomegaly.


METHODS
From November 1994 to January 2006, 36 patients with splenomegaly (final spleen weight > 700 g) were treated with laparoscopic operations for splenectomy in our hospital. Conventional LS was performed in 16 patients (7 men and 9 women, group 1) and HALS in the other 20 patients (12 men and 8 women, group 2). The patients' features, intraoperative details and the postoperative outcomes in the both groups were compared.


RESULTS
The both groups were comparable in the terms of patient's age ((38 +/- 12) years vs (43 +/- 14)years, P > 0.05), the greatest splenic diameter ((24 +/- 5)cm vs (27 +/- 7)cm, P > 0.05), preoperative platelet count ((118 +/- 94) x 10(9)/L vs (97 +/- 81) x 10(9)/L, P > 0.05) and diagnosis. Compared with LS group, operation time ((195 +/- 71) minutes vs (141 +/- 64) minutes, P < 0.05) was shorter, intraoperative blood loss ((138 +/- 80)ml vs (86 +/- 45)ml, P < 0.05) and conversion rate (4/16 vs 0/20, P < 0.05) were lower, but hospital stay ((5.3 +/- 3.8) days vs (7.4 +/- 1.6) days, P < 0.05) was longer in HALS group. There was no significant difference in the aspects of intraoperative and postoperative complication rate (2/16 vs 0/20, P > 0.05) or recovery time of gastrointestinal function ((16.3 +/- 11.6) hours vs (18.7 +/- 8.1) hours, P > 0.05) between the two groups.


CONCLUSIONS
In the cases of splenomegaly, HALS significantly facilitates the surgical procedure and reduces the operational risk, while maintaining the advantages of conventional LS. HALS is more feasible and more effective than conventional LS for the removal of splenomegaly.
Wang
Ke-Xin
KX
Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China.
Hu
San-Yuan
SY
Zhang
Guang-Yong
GY
Chen
Bo
B
Zhang
Hai-Feng
HF
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery*