Steep learning curve of laparoscopic splenectomy

Background and Purpose: In 1992, Ochsner Foundation Hospital was among the first institutions in which laparoscopic splenectomy was performed. The aim of this study is to review our experience and discuss the lessons learned. Methods: A retrospective review of 33 cases of laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP) (N = 22), autoimmune hemolytic a nemia (AIHA) (5), thrombocytopenic purpura (TTP) (2), and other disorders ( 4) at Ochsner Foundation Hospital between 1992 and 1999 was conducted. Seve ral measures, including rates of conversion to open splenectomy, were recor ded and analyzed. Results: Of the 33 cases, 26 (79%) were completed laparoscopically. Four we re converted to an open procedure secondary to bleeding and three secondary to difficulty in dissection. Six conversions to open surgery were necessar y during the first eight laparoscopic splenectomies and only one during our last 25 cases. Two patients required reoperations for bleeding. The averag e hospital stay after laparoscopic splenectomy was 2.3 days; eight patients stayed only 1 day. All of the TTP patients, 86% of the patients with ITP, and 40% of those with AIHA responded well to splenectomy. Conclusion: Laparoscopic splenectomy is a safe although complex procedure. Bleeding is the major complication but has been less common with experience . Even with today's technology, very large spleens are still extremely diff icult to remove. With the short recovery and ready acceptance of patients a nd physicians, this technique is being used with increasing frequency. A si gnificant learning curve exists for the safe completion of this challenging procedure.