OPTIMIZING LAPAROSCOPIC SPLENECTOMY - TECHNICAL DETAILS AND EXPERIENCE IN 59 PATIENTS

Background: Laparoscopic splenectomy (LS), Like other advanced laparos copic procedures, is still an evolving procedure. The indications for surgery, criteria for patient selection, and operative technique are n ot yet well defined. We have therefore modified the standard technique for performing LS in an attempt to optimize the procedure. Methods: O ver the past 2 years, we have performed LS in 59 patients. The last 43 patients were operated using a standardized technique that we believe to be optimal. It includes the routine use of the right lateral posit ion, operating through three trocars, the mass transection of the sple nic vasculature with a vascular endoscopic stapler, and the use of a s elf-retaining retrieval bag. Results: The average operating time was 7 9 min. Average blood loss was 95 cc, and average postoperative hospita lization was 2.3 days. There was one intraoperative complication and o ne postoperative complication. These results are superior to those we achieved earlier in our own experience, as well as to similar series t hat have been published recently. Conclusions: In our experience, the use of this new technique resulted in relatively short procedures with low morbidity. We believe that these results justify the use of LS as the procedure of choice for elective splenectomy in patients with nor mal or moderately enlarged spleens.