Technical advances in pediatric laparoscopy have had a beneficial impact on splenectomy

Purpose: The aim of this study was to demonstrate the effects of recent tec hnical advances on the safety and benefits of pediatric laparoscopic splene ctomy. Methods: A retrospective review was conducted of patients undergoing laparo scopic splenectomy from January 1998 to January 2000. Technical advances ut ilized during this period included the harmonic scalpel, a specialized flex ible hilar retractor, a larger, wire-rimmed specimen bag, and lateral patie nt positioning. Results: Laparoscopic splenectomy was performed successfully on 18 patients aged 3 to 17 years (median, 9). The indications were hereditary spherocyto sis (n = 10), idiopathic thrombocytopenic purpura (n = 5), and other (n = 3 ). Eight patients had concomitant procedures including cholecystectomy (n = 3), resection of an accessory spleen (n = 3), and other (n = 2). The media n operating time, including the concomitant procedures, was 125 minutes (ra nge, 70 to 235). Patients tolerated a regular diet on median postoperative day 1 (range, 1 to 3), and 16 were discharged home on or before postoperati ve day 2. None of the patients required blood product transfusion or conver sion to an open technique. There were no complications, and all patients ha d returned to usual activity by 2 weeks. Conclusion: With recent technological advances, the laparoscopic approach h as become easy to perform, safe, and should be considered the procedure of choice for pediatric splenectomy. Copyright (C) 2000 by W.B. Saunders Compa ny.