Laparoscopic splenectomy: technical aspects and preliminary results.

Unlabelled: The success of laparoscopic cholecystectomy has prompted the application of laparoscopic techniques to other abdominal procedures. Laparoscopic splenectomy poses certain specific difficulties for the control of the vascular pedicle, handling and mobilisation of a parenchymatous organ and the retrieval of the specimen. The aim of this paper is to present a technique for laparoscopic splenectomy.

Material and methods: Between February and October, 1993 we attempted laparoscopic splenectomy (LS) in 7 patients. Splenectomy was indicated in 5 patients for treatment of an idiopathic thrombocytopenic purpura and in two patients for treatment of hereditary microspherocytosis. One patient had concomitant cholelithiasis.

Results: LS was completed in 6 and converted in one patient to an open procedure due to blood from the splenic bed obscuring vision. Laparoscopic cholecystectomy and splenectomy were performed simultaneously in the patient with cholelithiasis. Three patients required transfusion of two packed cell units. In one patient, the bag broke during extraction of the spleen, and a minilaparotomy was required to remove the spleen. In one patient an accessory spleen was removed. Oral intake was started the next morning. Two patients developed pulmonary atelectasis. Analgesia requirements ranged between 2 and 10 doses, and postoperative stay ranged between 4-8 days.

Conclusion: LS is technically feasible, and offers the functional and aesthetic advantages of laparoscopic surgery.