A NEW TECHNIQUE FOR LAPAROSCOPIC SPLENECTOMY WITH MASSIVELY ENLARGED SPLEENS

Splenectomy is indicated in several hematological disorders and it can be particularly challenging in children with sickle cell disease, spl enomegaly, and recurrent sequestration. Over the last 6 months, we hav e developed a new technique for laparoscopic splenectomy (LS) for hype rsplenism and splenomegaly in five children with sickle cell disease. The average age of our patients was 6 years (range, 2-11), and the ave rage weight was 18.7 kg (range, 13.2-30.1). On preoperative ultrasound , spleen size index ranged from 0.42 to 0.76. For the LS, four trochar s were placed. One patient, who also underwent a laparoscopic cholecys tectomy, had six trochars placed, two of which were used for both chol ecystectomy and splenectomy. After laparoscopic mobilization of the sp leen and hilar vascular stapling, a Steiner electromechanical morcella tor was inserted through the 12-mm port to extract cores of splenic ti ssue until complete splenectomy was achieved. No patient required conv ersion to an open procedure or creation of a larger incision to remove the massively enlarged spleen. Operative time averaged 190 minutes; t he combined LS and cholecystectomy took 245 minutes. Postoperative len gth of stay was <2 days for all patients. There were no complications, and no patient required postoperative transfusion. Based on these ear ly findings, we conclude that intracorporeal coring of splenic tissue allows for safe and complete laparoscopic removal of very large spleen s in small children. It provides expedient recovery and minimal postop erative pain and scarring. This new technique should enable surgeons t o perform LS even in patients with massive splenomegaly, eliminating t he need for large and cumbersome intracorporeal bags or the creation o f additional incisions to remove the spleen.