title: Laparoscopic splenectomy is a safe method in cases of extremely large spleens.
abstract: BACKGROUND
  The aim of this study was to assess if there is a relationship between the outcome of laparoscopic splenectomy (LS) procedures and the size of the spleen, the learning curve, or the method of specimen retrieval.
  
  
  METHODS
  Between January 1, 2002 and December 31, 2013, 70 LS procedures were performed at our department. Based on the weight of the removed spleen, patients were divided into three groups: Group 1, <350 g (n=32); Group 2, 350-1000 g (n=15); and Group 3, >1000 g (n=7). The role of the learning curve was also analyzed with the first 20 surgeries considered as the learning period. The specimen was retrieved with morcellation through the lateral port site in 54 cases, whereas in 11 cases, the large spleen was retrieved through a Pfannenstiel incision.
  
  
  RESULTS
  The mean duration of surgery was 122 minutes. When considered by spleen weight, durations for Groups 1-3 were 117, 128, and 134 minutes, respectively. When considered by the learning curve, durations for learning and later periods were 149 and 111 minutes, respectively (P=.002). After the learning period, larger spleens were removed (208 versus 519 g; P=.02), and there were fewer conversions. The mean postoperative hospital stay was 5.1 days. In the 11 cases where the specimen was retrieved through a Pfannenstiel incision, the mean duration of surgery was 108 minutes, and the mean spleen weight was 1032 g.
  
  
  CONCLUSIONS
  Our study supports that the proposal that LS is safe and has numerous advantages, even in the case of massive splenomegaly. Our results were mainly affected by the spleen size and the learning curve.
authors: Department of Surgery, University of Szeged , Szeged, Hungary .
authors: Áron
authors: Á
authors: Nyilas
authors: Attila
authors: A
authors: Paszt
authors: Zsolt
authors: Z
authors: Simonka
authors: Szabolcs
authors: S
authors: Ábrahám
authors: Bernadett
authors: B
authors: Borda
authors: Eszter
authors: E
authors: Mán
authors: György
authors: G
authors: Lázár
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000473:pathology / Q000601:surgery*; D013163:Splenomegaly / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult