TECHNIQUE OF LAPAROSCOPIC SPLENECTOMY WITH A POWERED VASCULAR LINEAR STAPLER

The spleen may be removed by a laparoscopic technique, although the be nefits and associated morbidity of this approach are unknown. This stu dy reports a series of 28 consecutive patients (15 women; median age 3 9 (range 17-84) years) considered for laparoscopic splenectomy, becaus e of idiopathic thrombocytopenia in 14, human immunodeficiency virus-r elated thrombocytopenia in seven, autoimmune haemolytic anaemia in fou r, lymphoma in two and chronic lymphocytic leukaemia in one. In 23 cas es dissection was completed laparoscopically, with the patient in the right lateral position, using a four-cannula technique. Vascular isola tion was achieved with an Endo-GIA (powered vascular linear stapler). The spleen was removed by morselation within a retrieval bag (18 patie nts) or via either a Pfannenstiel or subcostal incision (five). The la st 14 procedures have all been completed successfully in a mean operat ing time of 105 min with discharge from hospital within a median of 3 days. One patient developed a clinically apparent deep venous thrombos is 23 days after operation, for which he required readmission. Electiv e laparoscopic splenectomy is a feasible although technically demandin g operation which may be performed safely and without associated morta lity by surgeons experienced in laparoscopic techniques.