PEDIATRIC LAPAROSCOPIC SPLENECTOMY USING THE LATERAL APPROACH

Laparoscopic splenectomy in children has been shown to be safe, to red uce postoperative pain and hospital stay, and to accelerate return to full activities. We describe our experience with a four-port ''lateral '' approach in 18 patients. Patients were placed in the lateral decubi tus position and the table was flexed to separate the left subcostal m argin and iliac crest, The camera port was inserted at the umbilicus a nd additional pelts were placed in the epigastrium and left lower quad rant. After mobilization of the splenic flexure a port was inserted in the left flank below the 12th rib for elevation of the spleen, A 30 d egrees laparoscope was used and the splenic vessels were controlled wi th an endo-GIA and/or clips. The spleens were placed in a bag, morcell ated, and extracted through a port site, Eight females and 10 males wi th a median age of 12.5 years (5-17 years) and weight of 55.5 kg (17-1 24 kg) underwent splenectomy of idiopathic thrombocytopenia purpora (1 0), spherocytosis (6), elliptocytosis (I), and Hodgkin's disease (I). The median operating time was 160 min (90-300 min) and median blood lo ss was 105 ml (5-350 ml). Accessory spleens were removed in four cases . Three patients required extensions of a port site to remove large sp leens which could not be placed in a bag. The sole complication was a transient pancreatitis with associated pleural effusion. The median po stoperative hospital stay was 2 days (1-11 days) and time to full acti vities was 8 days (3-25 days), The lateral approach affords excellent visualization of the splenic vessels, pancreas, and accessory spleens, This approach is safe and reliable and is our preferred approach for laparoscopic splenectomy in children.