Laparoscopic splenectomy: lessons from the learning curve.

Abstract

OBJECTIVE: Initial reports suggest that laparoscopic splenectomy is a difficult procedure with a steep learning curve and limited scope. The objective of this study was to review various approaches to simplify the operation. DESIGN: A descriptive study of a prospective database. SETTING: A tertiary care teaching hospital. PATIENTS: Fifty-one consecutive patients, seen over a 4-year period, who underwent laparoscopic splenectomy (partial laparoscopic splenectomy in 1 patient) for a wide variety of disorders. INTERVENTIONS: Anterior and lateral surgical approaches to laparoscopic splenectomy and the selective use of preoperative splenic artery embolization. MAIN OUTCOME MEASURES: Blood loss, morbidity, mortality and rate of conversion to open splenectomy, operating time and postoperative hospital stay. RESULTS: The morbidity (11%), death rate (2%), and rate of conversion were low. The recovery rate of accessory spleens was high (24%). Average operating time (3 hours), postoperative stay (3 days) and volume of blood loss improved with time. CONCLUSIONS: Laparoscopic splenectomy is a reliable procedure for patients with spleens less than 20 cm long. For spleens 20 to 30 cm long, preoperative embolization is advisable, and the surgeon should be experienced. Laparoscopic splenectomy should not be performed for spleens more than 30 cm long. The lateral approach has eliminated most of the difficulty with this procedure for spleens less than 20 cm long (no embolization). The anterior approach is reserved for large spleens and partial laparoscopic splenectomy (with embolization).