title: Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism.
abstract: OBJECTIVE
  The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension.
  
  
  METHODS
  From 1993 to 2008, 265 cirrhotic patients underwent LS. Child-Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or =1,000 mL), perisplenic collateral vessels, or Child-Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed.
  
  
  RESULTS
  There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients (P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min (P < 0.01) and from 506 to 171 g (P < 0.01), respectively.
  
  
  CONCLUSIONS
  With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. harrykw@v102.vaio.ne.jp
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Nao
authors.initials: N
authors.lastname: Kinjo
authors.forename: Kozou
authors.initials: K
authors.lastname: Konishi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshida
authors.forename: Go
authors.initials: G
authors.lastname: Anegawa
authors.forename: Shohei
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Uehara
authors.forename: Naotaka
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsutsumi
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Koushi
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Korenaga
authors.forename: Kenji
authors.initials: K
authors.lastname: Takenaka
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000473:pathology / Q000601:surgery*; D006975:Hypertension, Portal / Q000150:complications; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D013156:Splenectomy / Q000379:methods / Q000592:standards*