UNRESOLVED ISSUES IN LAPAROSCOPIC SPLENECTOMY

BACKGROUND: Laparoscopy is now expanding to surgery of intra-abdominal solid organs such as splenectomy for hematologic diseases. The purpos e of this study is to further demonstrate that laparoscopic splenectom y is feasible for the surgeon, teachable for the resident, and benefic ial to the patient and to revise prior contraindications to this minim ally invasive approach. METHODS: Thirty-three consecutive cases of lap aroscopic splenectomy were performed between May 1992 and March 1996. The series included 21 females and 12 males with a median age of 42 ye ars (range 19-19) and a median weight of 73 kg (range 36-115), Indicat ions included: immune thrombocytopenic purpura (20), hemolytic anemia (5), hereditary spherocytosis (4), infarction with abscess (1), Hodgki n's lymphoma (1), Gaucher's disease (1), and AIDS-related thrombocytop enia (1). Dissection was predominately performed with a new surgical i nstrument, the harmonic shears, and main vessels were controlled with clips. RESULTS: Thirty-two (97%) Of the cases were completed laparosco pically, with (3%) conversion to control hilar bleeding. Four patients underwent simultaneous cholecystectomy. The median spleen size was 13 cm (range 8-28) and median weight was 256 g (range 40-2100). Median o perating time was 242 minutes (range 85-515). Morbidity occurred in 2 (6%) patients: ileus and small bowel obstruction. Median hospital stay was 4 days (range 2-14). There was no mortality in our series. Median follow-up was 20 months (range 1-46) with no evidence of late surgica l complication or recurrent disease. CONCLUSION: Laparoscopic splenect omy may be successful in cases previously considered contraindicated, particularly splenomegaly and splenic infarct with abscess, it is a pr ocedure that can be learned under appropriate guidance in academic cen ters. (C) 1996 by Excerpta Medica, Inc.