title: Laparoscopic splenectomy: experience of a single center in a series of 300 cases.
abstract: BACKGROUND
  Laparoscopic splenectomy (LS) has gradually become the technique of choice for surgical removal of the spleen. The aim of this study was to evaluate the efficacy of LS in a large cohort of patients from a single center.
  
  
  METHODS
  From March 1992 to June 2010, 300 patients underwent LS at our hospital for predominantly hematologic disorders. The first 92 cases were performed using an anterior approach, whereas in the remaining 208 cases a lateral approach with a four-trocar technique was used. Patient demographics, diagnosis, and outcomes were reviewed.
  
  
  RESULTS
  Spleen volume was similar between the anterior (350 ml) and the lateral (370 ml) approaches. The lateral approach was associated with shorter operative time (60 vs. 80 min), less blood loss (30 vs. 110 ml), and no conversion (0 vs. 2.2 %) compared to the anterior approach. Reoperations were required in three patients (1.0 %) because of bleeding, subphrenic abscess, and intestinal ischemia. Postoperative complications were significantly fewer for the lateral (4.8 %) than for the anterior (31.5 %) approach and the hospital stay was shorter (3.1 vs. 5.2 days) and there was less postoperative pain. Splenectomy for hematologic malignancies resulted in a higher morbidity rate, more postoperative pain, and longer hospital stay. Overall mortality rate was 0.3 %. No late complications were observed during the 1-5-year follow-up.
  
  
  CONCLUSIONS
  LS using the lateral approach with the placement of four trocars can be considered the procedure of choice for both benign and malignant diseases affecting the spleen. Extensive experience and technical standardization help to avoid surgical pitfalls, providing an adequate control of hemostasis, the excision of accessory spleens (AS), and the avoidance of parenchymal rupture.
authors.affiliation: Department of Laparoscopic and Robotic Surgery, Azienda Ospedaliera dei Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy. francesco.corcione@ospedalemonaldi.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Corcione
authors.forename: Felice
authors.initials: F
authors.lastname: Pirozzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aragiusto
authors.forename: Francesco
authors.initials: F
authors.lastname: Galante
authors.forename: Antonio
authors.initials: A
authors.lastname: Sciuto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D013158:Splenic Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D015996:Survival Rate; D014463:Ultrasonography; D055815:Young Adult