Laparoscopic splenectomy 15 years after.
OBJECTIVE
The authors aim to analyze the impact of spleen size on the operative time, the splenic weight, the surgical technique, and the immediate clinical outcome in a series of 116 laparoscopic splenectomies (LS) performed in our department in the last 15 years. This study was also aimed to evaluate the efficacy of hand-assisted LS for splenomegaly.


METHODS
From July 1995 to January 2010, 116 LS were performed. In all the procedures, the 3- or 4-trocar lateral approach was used. The mean indication for surgery was hematologic diseases.


RESULTS
Of the 116 patients (69 females, mean age 41.7), the average weight of the spleens removed was about 450 g. The mean operative time was 100 minutes. Five patients underwent conversion. The mean duration of postoperative hospitalization was 4 days. No long-term complications were reported. Postoperative complications were reported in 3.5% of the cases.


CONCLUSIONS
The laparoscopic approach is safe and effective, with a shorter hospital stay and improved morbidity and mortality. LS may be considered as an acceptable indication even in cases of massive splenomegaly, and hand-assisted LS could be considered as a viable alternative to open surgery in patients with massive spleens.
SOD 1 Chirurgia Generale, d'Urgenza e Mininvasiva, Azienda Ospedaliero-Universitaria Careggi-Firenze, Firenze, Italy.
Tatiana
T
Bargellini
Jacopo
J
Martellucci
Alessandro
A
Bruscino
Paolo
P
Prosperi
Andrea
A
Valeri
D000328:Adult; D017558:Elective Surgical Procedures; D005260:Female; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D013156:Splenectomy; D013163:Splenomegaly / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome