Technique Of Laparoscopic Splenectomy

Background: Indications for laparoscopic splenectomy have rapidly increased and it is now considered the standard approach for almost all diseases requiring splenectomy, including benign and malignant disease. The aim is to evaluate the safety and effectiveness of laparoscopic splenectomy in a large cohort of patients in a laparoscopic referral center.Methods: We retrospectively analyzed 141 patients undergone surgery for spleen-related diseases from 2010 to 2019. All patients underwent laparoscopic splenectomy were selected according to European Association for Endoscopic Surgery guidelines. Exclusion criteria were American Society of Anesthesiologists (ASA) IV and severe portal hypertension and spleen diameter >30 cm. Early and mid-term results have been evaluated.Results: From 2010 to 2019, 108 patients underwent laparoscopic splenectomy. Mean operative time was 70 min (range, 50-120 min) with a conversion rate of 4.6% (5 patients). Among the 105 patients completed laparoscopically, 21 (20.4%) postoperative complications were reported: 2 early hemorrhage (2%), 4 (3.7%) fluid collections in the splenic fossa, 6 (5.5%) pneumonia and atelectasis and 9 (8.3%) cases of transient fever. Sixty-six patients (64.1%) reported mild pain, 22 patients (21.4%) moderate pain and 15 patients (14.6%) had severe pain. The 15 patients (14.6%) undergone specimen extraction through the suprapubic incision reported a higher pain compared with those in which spleen morcellation was performed (6.2 vs. 3.4, P<0.05). The mean hospital stay was 4 days (range, 3-6 days), with a mean time to return to normal activity of 7 days (range, 4-10 days). No late complications during the mean 3 years follow-up (range, 1-4 years) were observed.Conclusions: Laparoscopic splenectomy is safeness and effectiveness despite it requires extensive experience in laparoscopic surgery, adequate patient positioning and trocars positioning.