THE LATERAL APPROACH TO LAPAROSCOPIC SPLENECTOMY

BACKGROUND: Laparoscopic splenectomy has been shown to result in short er hospital stays and a quicker return to work than conventional splen ectomy. Having tried the anterior 5 trocar approach, we developed a 4 trocar lateral approach and now present our experience with 22 cases. METHODS: All patients were placed in the right lateral decubitus posit ion. A 10-mm trocar was inserted in the left subcostal region, 2 in th e flank, and a 5-mm trocar dorsally. A 30 degrees laparoscope was used . Splenectomy was performed for varying pathologies. RESULTS: Operatin g room (OR) time averaged 169 minutes, spleen weight 513 grams, and po stoperative (post-op) stays 5.4 days (median 3 days). One patient was converted to laparotomy. There were no deaths, post-op abscesses, panc reatic injuries, or bleeding complications. CONCLUSIONS: The lateral a pproach affords superior exposure, allowing easier dissection of splen ic hilar structures. Over varying patient habitus and spleen size it h as been demonstrated to he the approach of choice for laparoscopic spl enectomy. (C) 1997 by Excerpta Medica, Inc.