title: Consecutive concomitant laparoscopic splenectomy and cholecystectomy: an Italian experience of 30 patients and proposition of a technique.
abstract: BACKGROUND
  With recent advancements in the field of minimally invasive surgery, combined laparoscopic procedure is now being performed for treating coexisting abdominal pathologies during the same surgery. In some patients, spleen disorders are associated with gallbladder stones. Conventional surgery requires a wide upper abdominal incision for correct exposure of both organs. The aim of this study was to assess the feasibility and outcomes of concomitant laparoscopic treatment for coexisting spleen and gallbladder diseases.
  
  
  METHODS
  Thirty consecutive laparoscopic splenectomy (LS) plus laparoscopic cholecystectomy (LC) have been performed in our department between January 2000 and December 2009 (24% of 125 LS performed in this period). There were 11 female patients and 19 male patients, with a median age of 16.2 years (range: 4-55). Indications were hereditary spherocytosis for 22 cases, idiopathic thrombocytopenic purpura for 3 cases, thalassemia for 4 cases, and sickle cell disease for 1 case. Patients were operated on using right semilateral position, tilting the table from right to left, using a five-trocar technique in 25 cases and a four-trocar technique in the last 5 cases. Cholecystectomy was performed first, then splenectomy was achieved, and spleen was removed in an Endobag.
  
  
  RESULTS
  One patient required conversion to open procedure (3.3%) because of splenomegaly. Average operative time was 150 minutes (range: 90-240). Average length of stay was 3.5 days (range: 3-11). Mean blood loss was 60  mL (range: 30-500). Transfusion rate was 3.3%. Mean spleen size and weight were, respectively, 16.5  cm and 410  g. No perioperative mortality occurred in the series. We reported 3 cases of hemoperitoneum, of which one managed conservatively. The results using four trocars were comparable to those with five trocars.
  
  
  CONCLUSIONS
  With increasing institutional experience, concomitant laparoscopic splenectomy and cholecystectomy is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder diseases. The four-trocar technique guarantees good results.
authors.affiliation: Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Nobili
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
authors.forename: Arianna Libera
authors.initials: AL
authors.lastname: Ciravegna
authors.forename: Mattia
authors.initials: M
authors.lastname: Garancini
authors.forename: Luca
authors.initials: L
authors.lastname: Degrate
authors.forename: Fabio
authors.initials: F
authors.lastname: Uggeri
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic; D005240:Feasibility Studies; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D007558:Italy; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011446:Prospective Studies; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000150:complications / Q000601:surgery*; D055815:Young Adult