LAPAROSCOPIC-ASSISTED SPLENECTOMY USING A HAND-ACCESS PORT

Advanced laparoscopic procedures, such as laparoscopic splenectomy (LS ) are well described, but are generally not used outside units with a special interest in laparoscopic surgery. This particularly applies to LS, because of difficulties controlling the splenic pedicle and remov ing the spleen when completing the procedure. We describe five prospec tive cases of laparoscopic-assisted splenectomy (LAS) for idiopathic t hrombocytopaenic purpura (ITP), using a new, specialised port which al lows repeated insertion and removal of the surgeon's hand into the abd omen without loss of pneumoperitoneum. Spleens were removed intact thr ough the hand-access port. No patient developed any respiratory or oth er complications. Oral fluids were tolerated at a mean of 1.0 +/- 0.0 days and oral diet was tolerated at 1.4 +/- 0.5 days post-operatively Patients were discharged from hospital 3.2 +/- 1.9 days post-operative ly, LAS appears to offer the benefits of minimal hospital stay and ana lzgesia requirements which have previously been associated with LS. Ad ditional benefits, in comparison with LS, include increased tactile an d retractile ability, easier control of the splenic pedicle, removal o f an intact specimen for histological analysis and possibly easier loc ation of ectopic splenic tissue. This novel device may facilitate mini mally-invasive splenectomy outside specialised laparoscopic units.