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Tomuschat C, Aftzoglou M, Hagens J, Boettcher M, Reinshagen K. Limits in Laparoscopic Partial Splenectomy in Children. CHILDREN 2022; 9:children9050605. [PMID: 35626782 PMCID: PMC9140122 DOI: 10.3390/children9050605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
The aim of this paper is to assess the effectiveness and perioperative complications of splenic surgeries in children. In 41 splenectomies, an anterior abdominal laparoscopic approach was used, with 35 including a partial laparoscopic splenectomy. Of these, three needed a conversion to open. Six patients had a total splenectomy, three of which were open. Patients ranged in age from 5 to 18 years. Splenectomy was performed for a variety of causes, including hereditary spherocytosis (n = 20), splenic cysts (n = 13), sickle cell disease (n = 3), primary malignancy (n = 1), sepsis (n = 1), embolism (n = 1), anemia (n = 1), and hypersplenism (n = 1). The average length of stay was 7.6 days, and the average operation time was 169.3 min. Pleural effusion in the left hemithorax was found in 31.6% of the patients, with 5.3% requiring a thorax drain. The majority of patients had the highest platelet count two weeks after surgery. There was no evidence of wound infection, pancreatic leak, colon perforation, or postoperative sepsis. The most encountered perioperative complication was bleeding with the need of transfusion (n = 6), and one patient needed a diaphragm repair. A partial splenectomy (PS) can be a difficult procedure with a steep learning curve. For most children who require a splenic operation, this should be the primary procedure of choice.
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Affiliation(s)
- Christian Tomuschat
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
- Correspondence: ; Tel.: +49-(0)-15222825958; Fax: +49-(0)-40-7410-40605
| | - Michail Aftzoglou
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
| | - Johanna Hagens
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
| | - Michael Boettcher
- Department of Paediatric Surgery, Mannheim University Medical Center (UMM), 68167 Mannheim, Germany;
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
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Shelby R, Kulaylat AN, Villella A, Michalsky MP, Diefenbach KA, Aldrink JH. A comparison of robotic-assisted splenectomy and laparoscopic splenectomy for children with hematologic disorders. J Pediatr Surg 2021; 56:1047-1050. [PMID: 33004189 DOI: 10.1016/j.jpedsurg.2020.08.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Laparoscopic splenectomy (LS) is the standard of care for hematologic disorders requiring splenectomy. Less is known about the outcomes following robotic-assisted splenectomy (RS) for this indication. Our aim was to describe outcomes of RS to LS in pediatric patients with hematologic disorders in our institution. METHODS A single institution retrospective review was performed of pediatric patients undergoing LS vs. RS from 2014 to 2019. Patient demographics, diagnosis, spleen size, hospital length of stay (LOS), operative time, post-operative opioid use, and hospital charges were evaluated. Standard univariate analyses were performed. RESULTS Twenty-four patients were included in the study (14 LS, 10 RS). The mean spleen size at the time of surgery was larger in the RS group compared to LS (14.5 cm vs. 12.2 cm, p = 0.03). Operative time between the two cohorts was comparable (RS 140.5 vs LS 154.9 min). Median LOS for RS was shorter than LS (2.1 vs. 3.2 days, p = 0.02). Cumulative postoperative opioid analgesic requirements were not significantly different between the groups (17.4 mg vs. 30.5 mg). The median hospital charges, including the surgical procedure and hospital stay were higher in the RS group ($44,724 RS vs $30,255 LS, p = 0.01). CONCLUSION Robotic splenectomy is a safe and feasible option for pediatric patients with hematologic disorders, and was associated with decreased LOS but higher charges compared to laparoscopic splenectomy. Further studies are required to delineate the optimal use and potential benefits of robot-assisted surgical techniques in children. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rita Shelby
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Afif N Kulaylat
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Anthony Villella
- Department of Pediatrics, Division of Hematology, Oncology, and Bone Marrow Transplantation, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Jennifer H Aldrink
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
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Romboli A, Annicchiarico A, Morini A, Castro Ruiz C, Pagliai L, Montali F, Costi R. Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases. J Laparoendosc Adv Surg Tech A 2021; 31:1130-1142. [PMID: 33471586 DOI: 10.1089/lap.2020.0769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.
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Affiliation(s)
- Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Alfredo Annicchiarico
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Andrea Morini
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Carolina Castro Ruiz
- Unità Operativa di Chirurgia Generale, Ospedale Civile di Guastalla, Guastalla, Italia
| | - Lorenzo Pagliai
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Filippo Montali
- Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
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Costi R, Castro Ruiz C, Romboli A, Wind P, Violi V, Zarzavadjian Le Bian A. Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases. J Pediatr Surg 2019; 54:1527-1538. [PMID: 30665627 DOI: 10.1016/j.jpedsurg.2018.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset. METHODS A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy. RESULTS Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients. CONCLUSIONS Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia.
| | | | - Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Philippe Wind
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France
| | - Vincenzo Violi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris "Descartes", Paris, France
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Correia JG, Moreira N, Costa Almeida CE, Reis LS. Partial Splenectomy in the treatment of an adult with β thalassemia intermedia: A case report. Int J Surg Case Rep 2018; 41:446-449. [PMID: 29546013 PMCID: PMC5702856 DOI: 10.1016/j.ijscr.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Thalassemia is a common disease which treatment is often based on splenectomy. The risks associated with total splenectomy stimulated partial splenectomy as a potentially alternative therapy. Case presentation A 45 year-old female patient with long term follow-up for β thalassemia intermedia started to develop signs of hypersplenism and iron overload. A partial splenectomy was performed and was observed a marked hematologic improvement while preserving the desired splenic function. Discussion Partial splenectomy proved to provide a persistent decrease in hemolytic rate while preserving the integrity of splenic phagocytic function, presenting itself as an effective alternative to total splenectomy. After being subjected to partial splenectomy, our patient experienced a sustained control of hemolysis and showed no signs of hypersplenism or iron overload. No splenic regrowth or infectious complications were observed. The major drawbacks of partial splenectomy are the increased risk of intra- and postoperative bleeding, splenic remnant torsion and splenic regrowth. Conclusion Partial splenectomy is an alternative to total splenectomy for the treatment of adult β Thalassemia intermedia patients avoiding the risks associated with total splenectomy.
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Affiliation(s)
- João Guardado Correia
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal.
| | - Nídia Moreira
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
| | - Carlos Eduardo Costa Almeida
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
| | - Luís Simões Reis
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
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Long-term follow-up of subtotal splenectomy for hereditary spherocytosis: a single-center study. Blood 2016; 127:1616-8. [PMID: 26773041 DOI: 10.1182/blood-2015-11-679357] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Partial splenectomy in the era of minimally invasive surgery: the current laparoscopic and robotic experiences. Surg Endosc 2015; 29:3618-27. [PMID: 25740639 DOI: 10.1007/s00464-015-4118-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/13/2015] [Indexed: 12/13/2022]
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8
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Casale M, Perrotta S. Splenectomy for hereditary spherocytosis: complete, partial or not at all? Expert Rev Hematol 2014; 4:627-35. [DOI: 10.1586/ehm.11.51] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Eskandarlou M, Derakhshanfar A. Introduction of a simple technique for partial splenectomy in multiple trauma patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e9072. [PMID: 24693413 PMCID: PMC3955528 DOI: 10.5812/ircmj.9072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 10/12/2013] [Accepted: 10/29/2013] [Indexed: 11/16/2022]
Abstract
Background: The spleen is the most commonly injured intraperitoneal organ in multiple trauma patients. Total splenectomy results in immunodeficiency and predisposes patients to certain infections. Objectives: Performing partial splenectomy with a safe, simple, and definite technique in trauma patients with hemodynamic instability and accompanying intra-abdominal injury could play an important role in the preservation of immune function and reducing morbidity. Patients and Methods: From 2006 to 2009, a total of 20 patients underwent partial splenectomy, at Mobasher and Be’sat hospitals. Patients with splenic injuries of up to stage IV and grade 3 shocks underwent partial splenectomy. The operations were performed without vascular isolation and by wedge resection of the injured splenic tissue and repair with chromic 2/0 sutures in two rows. Three months later, patients were evaluated by a Tc99 liver-spleen scan, complete blood count, and blood smear. Results: There were 16 male and four female patients with an age range of 4 to 54 years old. Ten patients had additional intra and extra abdominal injuries. The salvaged spleen tissue was approximately 30% in nine patients, 40 to 50% in two, and more than 50% in another nine patients. The operation time was less than three hours and hospital stay was 3 to 15 days for 90% of the patients. No complications occurred after the surgery or during the follow up. For all patients, the complete blood count, peripheral smear, and liver-spleen scan were normal after six months. Conclusions: Partial splenectomy with preserving at least 30% of the splenic tissue can be performed for trauma patients using wedge resection of the injured splenic tissue and repair by chromic 2/0 sutures in two rows. Using this technique, there is no need for vascular isolation or hemostatic materials. Splenic function is presented and associated intra and extra abdominal injuries are not contraindications for partial splenectomy.
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Affiliation(s)
- Mehdi Eskandarlou
- Department of Surgery, Hamedan University of Medical Sciences, Hamedan, IR Iran
| | - Amir Derakhshanfar
- Department of Surgery, Hamedan University of Medical Sciences, Hamedan, IR Iran
- Corresponding Author: Amir Derakhshanfar, Department of Surgery, Hamedan University of Medical Sciences, Hamedan, IR Iran. Tel: +98-9181111499, E-mail:
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Laparoscopic splenectomy in patients with hereditary spherocytosis: report on 12 consecutive cases. Updates Surg 2013; 65:277-81. [DOI: 10.1007/s13304-013-0236-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
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Da Costa L, Galimand J, Fenneteau O, Mohandas N. Hereditary spherocytosis, elliptocytosis, and other red cell membrane disorders. Blood Rev 2013; 27:167-78. [PMID: 23664421 DOI: 10.1016/j.blre.2013.04.003] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hereditary spherocytosis and elliptocytosis are the two most common inherited red cell membrane disorders resulting from mutations in genes encoding various red cell membrane and skeletal proteins. Red cell membrane, a composite structure composed of lipid bilayer linked to spectrin-based membrane skeleton is responsible for the unique features of flexibility and mechanical stability of the cell. Defects in various proteins involved in linking the lipid bilayer to membrane skeleton result in loss in membrane cohesion leading to surface area loss and hereditary spherocytosis while defects in proteins involved in lateral interactions of the spectrin-based skeleton lead to decreased mechanical stability, membrane fragmentation and hereditary elliptocytosis. The disease severity is primarily dependent on the extent of membrane surface area loss. Both these diseases can be readily diagnosed by various laboratory approaches that include red blood cell cytology, flow cytometry, ektacytometry, electrophoresis of the red cell membrane proteins, and mutational analysis of gene encoding red cell membrane proteins.
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Affiliation(s)
- Lydie Da Costa
- AP-HP, Service d'Hématologie Biologique, Hôpital R. Debré, Paris, F-75019, France.
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Mouttalib S, Rice HE, Snyder D, Levens JS, Reiter A, Soler P, Rothman JA, Thornburg CD. Evaluation of partial and total splenectomy in children with sickle cell disease using an Internet-based registry. Pediatr Blood Cancer 2012; 59:100-4. [PMID: 22238140 PMCID: PMC3330148 DOI: 10.1002/pbc.24057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 11/28/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND Clinical outcomes of children with sickle cell disease (SCD) who undergo total or partial splenectomy (PS) are poorly defined. The purpose of this retrospective study was to initiate an Internet-based registry to facilitate analysis of clinical outcomes for these children. We hypothesized that both surgical procedures would be well tolerated and would eliminate risk of splenic sequestration. METHODS We developed a web-based registry using the Research Electronic Data Capture (REDCap) platform. Children were included if they had SCD and underwent total splenectomy (TS) or PS between 2003 and 2010. Clinical outcomes were compared between cohorts, with follow-up to 1 year. RESULTS Twenty-four children were included, TS (n = 15) and PS (n = 9). There were no differences in surgical time or intraoperative blood loss. The length of stay was longer after PS (4.1 ± 1.7 days) compared to TS, (2.4 ± 1.2 days, P = 0.02). Within 30 days of surgery, 2 (20%) patients had acute chest syndrome (ACS) following TS and 2 (15%) patients had ACS after PS. During 1-year follow-up, no patient in either cohort had recurrent splenic sequestration, venous thrombosis or overwhelming postsplenectomy sepsis. All children who were transfused preoperatively to prevent recurrent splenic sequestration successfully discontinued transfusions. CONCLUSIONS Both TS and PS result in favorable hematologic outcomes and low risk of adverse events for children with SCD. A REDCap-based registry may facilitate data entry and analysis of clinical outcomes to allow for comparison between different types of splenectomy.
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Affiliation(s)
- Sofia Mouttalib
- Department of Surgery, Duke University Medical Center, Durham, NC,Centre Hospitalier Universitaire de Toulouse, France
| | - Henry E. Rice
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Denise Snyder
- Department of Epidemiology and Biostatistics Duke University School of Nursing, Durham, NC
| | - Justin S. Levens
- Department of Epidemiology and Biostatistics Duke University School of Nursing, Durham, NC
| | - Audra Reiter
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Pauline Soler
- Centre Hospitalier Universitaire de Toulouse, France
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Vasilescu C, Stanciulea O, Tudor S. Laparoscopic versus robotic subtotal splenectomy in hereditary spherocytosis. Potential advantages and limits of an expensive approach. Surg Endosc 2012; 26:2802-9. [PMID: 22476842 DOI: 10.1007/s00464-012-2249-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 03/06/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study was designed to compare the laparoscopic subtotal splenectomy with the robotic approach in patients with hereditary spherocytosis. METHODS Thirty-two consecutive subtotal splenectomies by minimal approach in patients with hereditary spherocytosis were analyzed (10 robotic vs. 22 laparoscopic subtotal splenectomies). RESULTS A significant difference was found for the robotic approach regarding blood loss, vascular dissection duration, and splenic remnant size. Follow-up for 4-103 months was available. CONCLUSIONS Subtotal splenectomy seems to be a suitable candidate for robotic surgery, requiring a delicate dissection of the splenic vessels and a correct intraoperative evaluation of the splenic remnant. Robotic subtotal splenectomy is comparable to laparoscopy in terms of hospital stay and complication. The main benefits are lower blood loss rate, vascular dissection time, and a better evaluation of the splenic remnant volume.
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Affiliation(s)
- Catalin Vasilescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania.
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