Abstract
Between early 1992 and December 1994, laparoscopic splenectomy was performed in 27 patients with idiopathic thrombocytopenia (ITP), hairy-cell leucemia, HIV, or Hodgkin's disease. In all cases medical treatment, especially cortisone therapy, failed. In Hodgkin's disease the splenectomy was combined with liver biopsies and dissection of parailiacal, paraaortic, and mesenteric lymph nodes for abdominal staging.
The operation was performed using four trocars; the splenic vessels were divided by a linear stapler. In general the spleen was removed in a bag through a slightly enlarged trocar incision or after morcellation. Three patients needed a small laparotomy for the removal (laparoscopic assisted). In a recent case of Hodgkin's disease the intact spleen was removed via posterior colpotomy.
In 22 of 27 cases (81%) the operation was finished laparoscopically. Five times a conversion to conventional laparotomy was necessary because of bleeding of enlarged lymph nodes at the hilum. Wound infections occurred in two cases. In one patient with ITP the platelet count did not improve and continuous blood loss led to relaparotomy at the 1st postoperative day. No surgical bleeding was found. All patients tolerated a fluid diet at the 1st postoperative day and hospitalization time was 4.4 days (range 3–14).
Regarding the low complication rate and the advantages of a smaller abdominal trauma in the postoperative period, the laparoscopic approach for elective splenectomy and laparoscopic abdominal staging has a substantial benefit for the patients.
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References
Akle CA, Wickham JE, Gravett P, Dick R (1993) Laproscopic splenectomy. Br J Surg 80(1): 126
Bowsher WG, Clarke A, Clarke DG, Costello AJ (1992) Laparoscopic pelvic lymph node dissection. Br J Urol 70:276–279
Carroll BJ, Phillips EH, Semel CJ, Fallas M, Morgenstern L (1992) Laparoscopic splenectomy. Surg Endosc 6(4): 183–185
Childers JM, Hatch K, Surwit EA (1992) The role of laparoscopic lymphadenectomy in the management of cervical carcinoma. Gynecol Oncol 47:38–43
Cushieri A, Shimi S, Banting S, Vander Velpen G (1992) Technical aspects of laparoscopic splenectomy: hilar segmental devascularization and instrumentation. J R Coll Surg Edinb 37(6): 414–416
Delaitre B, Maignien B (1991) Splenectomy by the coelioscopic approach. Report of a case (letter). Presse Med 20(44): 2263
Delaitre B, Maignien B, Icard P (1992) Laparoscopic splenectomy. Br J Surg 79(12): 1334
Hashizume M, Sugimachi K (1992) Laparoscopic splenectomy with an ultrasound disector (letter). N Engl J Med 327(6): 438
Lefor AT, Melvin WS, Bailey RW, Flowers JL (1993) Laparoscopic splenectomy in the management of immune thrombocytopenia. Surgery 114(3): 613–618
Mauch P, Somers R (1992) Controversies in the use of diagnostic staging laparotomy and splenectomy in the management of Hodgkin's disease. Ann Oncol 3: 41–43
Parra RO, Andrus CH, Boullier JA (1992) Staging laparoscopic lymph node dissection. Experiences and indications. Arch Surg 127: 1294–1297
Zornig C, Emmermann A, Peiper M, Zschaber R, Broelsch CE (1993) Laparoskopische Splenektomie. Chirurg 64(4): 314–316
Zornig C, Emmermann A, Peiper M, Richter M, Weh HJ (1993) Staging-Laparoskopie beim Morbus Hodgkin—Vollwertige Alternative zur Staging-Laparotomie. Dtsch Med Wochenschr 118: 1401–1404
Zornig C, Emmermann A, vWaldenfels HA, Felixmüller C (in press) Die Kolpotomie zur Präparatebergung in der laparoskopischen Chirurgie. Chirurg
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Emmermann, A., Zornig, C., Peiper, M. et al. Laparoscopic splenectomy. Surg Endosc 9, 924–927 (1995). https://doi.org/10.1007/BF00768896
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DOI: https://doi.org/10.1007/BF00768896