title: Laparoscopic splenectomy using pneumoperitoneum or gasless abdominal wall lifting: a 15-year single institution experience.
abstract: BACKGROUND
  Laparoscopic splenectomy using pneumoperitoneum has been performed since 1992. The gasless abdominal wall-lifting method for laparoscopic splenectomy was introduced as an alternative. This retrospective study was undertaken to compare results using the two techniques.
  
  
  METHODS
  Between 1995 and 2010, 54 patients underwent laparoscopic splenectomy at a single institution; 30 underwent the procedure using the gasless technique and 24 using pneumoperitoneum. There were no significant differences between the two groups regarding age, sex or BMI, but more patients underwent concurrent operations in the pneumoperitoneum group. The abdominal wall-lift system with subcutaneous K-wires was used for the gasless method.
  
  
  RESULTS
  Intraoperative blood loss was similar in the two groups (193.0 ± 196.7 mL gasless, 217.3 ± 296.6 mL pneumoperitoneum; P > 0.05), but operative time (182.1 ± 92.1 min, 135.1 ± 46.1 min; P < 0.05), and resected spleen weight (306.1 ± 297.7 g, 138 ± 81.0 g; P < 0.05) were significantly different. In the gasless group, additional procedures included conversion (n = 1), mini-laparotomy (n = 2), and CO(2) insufflation (n = 2). Excluding the concurrent living-related kidney donor patients, hospital stay was similar (6.9 ± 2.5 days, 6.3 ± 2.0 days, P > 0.05).
  
  
  CONCLUSIONS
  Although gasless laparoscopic splenectomy is feasible, there are disadvantages, particularly the restricted operative working space in some patients. These results suggest that either technique may be used on an individual basis in patients undergoing laparoscopic splenectomy.
authors: Department of Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan. mhyodo@jichi.ac.jp
authors: M
authors: M
authors: Hyodo
authors: N
authors: N
authors: Sata
authors: M
authors: M
authors: Koizumi
authors: Y
authors: Y
authors: Sakuma
authors: K
authors: K
authors: Kurihara
authors: A T
authors: AT
authors: Lefor
authors: J
authors: J
authors: Ohki
authors: H
authors: H
authors: Nagai
authors: Y
authors: Y
authors: Yasuda
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000601:surgery; D002648:Child; D003560:Cysts / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008223:Lymphoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D012189:Retrospective Studies; D013156:Splenectomy / Q000295:instrumentation / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery; D013921:Thrombocytopenia / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult