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Hand-assisted Laparoscopic Splenectomy Advantages Over Complete Laparoscopic Splenectomy For Splenomegaly. Surg Laparosc Endosc Percutan Tech 2019; 29:109-112. [PMID: 30720697 DOI: 10.1097/sle.0000000000000640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is generally applied for splenectomy, However, it also brings some technical challenges, especially for splenomegaly. Hand-assisted laparoscopic splenectomy (HALS) can help to overcome these drawbacks while maintaining the superiority of LS. This study was aimed to evaluate the efficacy and advantage of HALS for splenomegaly. MATERIALS AND METHODS Between January 2014 and November 2017, 91 patients with splenomegaly in 2 surgical centers were randomly assigned to either HALS (n=45) or LS (n=46). The patients' characteristics, intraoperative details, and the postoperative outcomes in both groups were compared. RESULTS Baseline features (sex, age, main diameter, Child-Pugh grade) of both groups had no significant difference (P<0.05). Compared with LS group, the HALS group operation time (141±46 vs. 172±43 min; P=0.001) was shorter, intraoperative blood loss [215 (122.332) vs. 230 (130.740) mL; P=0.026], hospital expenses (5.5±1.5 vs. 6.4±2.4 WanRMB; P=0.022), and conversion rate (1/45 vs. 9/46; P=0.015) were lower. However, there was no significant difference for hospital stay (6.4±2.8 vs. 6.7±3.0 d; P=0.662) and complications (15/45 vs. 12/46; P=0.893) between the 2 groups. In addition, there were no significant differences in postoperative white blood cell (10.6±2.9 vs. 10.9±3.5; P=0.747), AST [61 (47.94) vs. 57 (37.86) U/L; P=0.513], and ALT [68 (54.120) vs. 55 (36.99) U/L; P=0.302] levels. CONCLUSIONS HALS can maximize the benefits for patients, while maintaining the advantages of LS and open splenectomy. It is the ideal surgical treatment for splenomegaly.
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Huang Y, Wang XY, Wang K. Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A meta-analysis. World J Clin Cases 2019; 7:320-334. [PMID: 30746373 PMCID: PMC6369387 DOI: 10.12998/wjcc.v7.i3.320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hand-assisted laparoscopic splenectomy (HALS) can help overcome the drawbacks of laparoscopic splenectomy (LS) while maintaining its advantages.
AIM To evaluate the efficacy and advantages of HALS for splenomegaly.
METHODS The relevant literature was reviewed using the PubMed, EMBASE, Cochrane, Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from 16 trials who met the inclusion criteria were selected.
RESULTS In pure splenectomy, blood loss volume (P < 0.001) and conversion rate (P = 0.008) were significantly lower in the HALS group than in the LS group. Conversely, for splenomegaly, the operative time (P = 0.04) was shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach (DUS), the operative time (P = 0.04) was significantly shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.
CONCLUSION HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.
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Affiliation(s)
- Yong Huang
- Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Yun Wang
- Department of Operating Room, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Kai Wang
- Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2008; 22:821-48. [PMID: 18293036 DOI: 10.1007/s00464-007-9735-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 11/23/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude laparoscopic splenectomy are not clearly defined. In view of this, the European Association for Endoscopic Surgery (EAES) has developed clinical practice guidelines for LS. METHODS An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. A consensus development conference using a nominal group process convened in May 2007. Its recommendations were presented at the annual EAES congress in Athens, Greece, on 5 July 2007 for discussion and further input. After a further Delphi process between the experts, the final recommendations were agreed upon. RESULTS Laparoscopic splenectomy is indicated for most benign and malignant hematologic diseases independently of the patient's age and body weight. Preoperative investigation is recommended for obtaining information on spleen size and volume as well as the presence of accessory splenic tissue. Preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections is recommended in elective cases. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and prolonged anticoagulant prophylaxis to high-risk patients. The choice of approach (supine [anterior], semilateral or lateral) is left to the surgeon's preference and concomitant conditions. In cases of massive splenomegaly, the hand-assisted technique should be considered to avoid conversion to open surgery and to reduce complication rates. The expert panel still considered portal hypertension and major medical comorbidities as contraindications to LS. CONCLUSION Despite a lack of level 1 evidence, LS is a safe and advantageous procedure in experienced hands that has displaced open surgery for almost all indications. To support the clinical evidence, further randomized controlled trials on different issues are mandatory.
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Affiliation(s)
- B Habermalz
- Institute for Research in Operative Medicine, University Witten/Herdecke, Witten/Herdecke, IFOM, Ostmerheimer Strasse 200, 51109, Köln, Germany
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Romano F, Gelmini R, Caprotti R, Andreotti A, Guaglio M, Franzoni C, Uggeri F, Saviano M. Laparoscopic Splenectomy: Ligasure Versus EndoGIA: A Comparative Study. J Laparoendosc Adv Surg Tech A 2007; 17:763-7. [DOI: 10.1089/lap.2007.0005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Fabrizio Romano
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Roberta Gelmini
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Caprotti
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Alessia Andreotti
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Guaglio
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Chiara Franzoni
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Uggeri
- Department of General Surgery, San Gerardo Hospital, University of Milan–Bicocca, Monza, Italy
| | - Massimo Saviano
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Palanivelu C, Jani K, Malladi V, Shetty R, Senthilkumar R, Maheshkumar G. Early Ligation of the Splenic Artery in the Leaning Spleen Approach to Laparoscopic Splenectomy. J Laparoendosc Adv Surg Tech A 2006; 16:339-44. [PMID: 16968178 DOI: 10.1089/lap.2006.16.339] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A variety of approaches have been proposed for laparoscopic splenectomy, including the anterior approach, the lateral approach (hanging spleen technique), and the semilateral approach (leaning spleen technique). We advocate a leaning spleen approach with early ligation of the splenic artery. MATERIALS AND METHODS Since 1997, we have performed 120 laparoscopic splenectomies using the leaning spleen approach along with early ligation of the splenic artery. The patient is placed in a 70-degree semi-right lateral position. The operative steps are: exposure of the lesser sac, control of the splenic artery, mobilization of the splenic flexure, division of the splenocolic ligament, division of the splenophrenic ligament, hilar mobilization, mobilization of the upper pole of the spleen, and removal of the specimen. RESULTS The most common indication for surgery was autoimmune hemolytic anemia (35.8%). One patient had severe perisplenitis with extensively vascularized adhesions, which led to oozing during surgery obscuring the laparoscopic view, requiring conversion to open surgery. The mean spleen diameter was 22.8 cm (range, 12.5-37.0 cm) on imaging. The mean operative time was 85 minutes (range, 54-124 minutes). Concomitant laparoscopic cholecystectomy for pigment stone cholelithiasis was performed in 8.3% of the patients. Accessory splenic tissue was found in 4.2%. The average hospital stay was 3 days (range, 1-6 days). There were no significant postoperative complications. The average follow-up has been 5.4 years (range, 1 month-9 years). CONCLUSION In adopting the modification of early ligation of the splenic artery in the leaning spleen approach, we believe we have helped to advance laparoscopic splenectomy.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/surgery
- Catheters, Indwelling
- Cholecystectomy, Laparoscopic
- Cholecystolithiasis/surgery
- Colon, Transverse/surgery
- Echinococcosis/surgery
- Follow-Up Studies
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/etiology
- Humans
- Laparoscopy/methods
- Length of Stay
- Ligation/instrumentation
- Ligation/methods
- Purpura, Thrombocytopenic, Idiopathic/surgery
- Spherocytosis, Hereditary/surgery
- Splenectomy/instrumentation
- Splenectomy/methods
- Splenic Artery/surgery
- Splenic Vein/surgery
- Splenomegaly/surgery
- Treatment Outcome
- Ultrasonography, Doppler, Color
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Gelmini R, Romano F, Quaranta N, Caprotti R, Tazzioli G, Colombo G, Saviano M, Uggeri F. Sutureless and stapleless laparoscopic splenectomy using radiofrequency: LigaSure device. Surg Endosc 2006; 20:991-4. [PMID: 16738999 DOI: 10.1007/s00464-005-0470-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 12/18/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bleeding is the main complication and cause of conversion during laparoscopic splenectomy (LS). We present the advantages of the LigaSure vessel sealing system added to the lateral approach for achieving safe vascular control. METHODS We performed 63 consecutive LS in a 3-year period using LigaSure in two affiliated university hospitals. We employed a right semilateral position technique with dissection of the spleen and vessel sealing using LigaSure. Forty-two patients had benign hematological disease, 19 had malignant disease, and two had splenic cysts. RESULTS A total of 58 LS were completed with five conversions due to hilar bleeding (three cases), difficult dissection (one), and massive splenomegaly (one). In all but five patients, blood loss was less than 100 ml. No transfusions were needed. There were five postoperative complications: portal thrombosis (one case), hemoperitoneum (two), surgical wound infection (one), and pleural effusion (one). CONCLUSIONS The use of LigaSure, and the semilateral position, results in a gain of time and safety. Furthermore, average intraoperative bleeding is very low.
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Affiliation(s)
- R Gelmini
- Department of Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, via del Pozzo, 71 - 41100, Modena, Italy.
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Yüney E, Höbek A, Keskin M, Yilmaz O, Kamali S, Oktay C, Bender O. Laparoscopic splenectomy and LigaSure. Surg Laparosc Endosc Percutan Tech 2005; 15:212-5. [PMID: 16082308 DOI: 10.1097/01.sle.0000174550.94671.30] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Laparoscopic splenectomy (LS) is a preferred choice, especially for hematologic diseases. We present the advantages of the use of LigaSure (energy-based equipment that works by applying a precise amount of bipolar energy and pressure to the tissue, achieving a permanent seal) for achieving a precise hemostasis, thus making the LS easier. We have performed LS using LigaSure on 10 patients (4 female, 6 male; mean age, 36 years [range, 16-58]) between December 2002 and August 2003. All patients had ITP. There were no conversion to open surgery. Mean dimensions of spleens were 99 x 49 mm (range, 85 x 36-118 x 60). Intraoperative blood loss was no more than 100 mL in any patients (range, 20-100; mean, 60). The average operative time was 93 minutes (range, 60-155). There were no complications in the postoperative period. The average postoperative stay was 4.3 days (range, 3-7). LS using LigaSure is a safe and time-sparing procedure with almost no complications in this small initial series.
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Affiliation(s)
- Enis Yüney
- SSK Okmeydani Training Hospital, Istanbul, Turkey
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Asoglu O, Ozmen V, Gorgun E, Karanlik H, Kecer M, Igci A, Unal ES, Parlak M. Does the Early Ligation of the Splenic Artery Reduce Hemorrhage During Laparoscopic Splenectomy? Surg Laparosc Endosc Percutan Tech 2004; 14:118-21. [PMID: 15471015 DOI: 10.1097/01.sle.0000129397.50124.fa] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this study was to investigate whether early ligation of the splenic artery before splenic lysis has an effect on the amount of intraoperative bleeding and conversion rate during laparoscopic splenectomy. Laparoscopic splenectomy was performed in 34 patients with hematological diseases or splenic cysts between January 1993 and January 2003. The splenic artery was ligated before manipulation of the spleen in 22 patients (group 1) and laparoscopic splenectomy was performed with no previous ligation of the splenic artery in 12 patients (group 2). Prospective data was collected and the groups compared regarding intraoperative blood loss, platelet count, operative time, hospital stay, and conversion rate. Laparoscopic splenectomy was successfully completed in 30 (88%) patients. One patient in group 1 (5%) and 3 patients in group 2 (25%) required conversion due to bleeding. Estimated average blood loss was 161 mL (range 70-450 mL) in group 1, and 292 mL (range 100-700 mL) in group 2 (P < 0.001). The average operative time was 140 minutes (range 80-240) in group 1, and 155 minutes (range 80-200) in group 2 (P > 0.05). There were no statistically significant differences between the two groups comparing splenic size, conversion rate, hospital length of stay and platelet count. Early ligation of the splenic artery is feasible, safe and effective and may provide easy dissection and manipulation of the spleen during laparoscopic splenectomy with decreased intraoperative blood loss and no extension of the operative time.
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Affiliation(s)
- Oktar Asoglu
- Istanbul University, Istanbul Medical Faculty, Department of General Surgery, Istanbul, Turkey
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Cirugía laparoscópica asistida con la mano. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)72017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Targarona EM, Trias M. Regarding: "splenectomy revised: manually assisted splenectomy with the dexterity device--a feasibility study in 22 patients" by Meijer et al. J Laparoendosc Adv Surg Tech A 2001; 11:177-8. [PMID: 11441997 DOI: 10.1089/10926420152389350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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