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Bhardwaj N, Singh A. Splenectomy Modulates the Erythrocyte Turnover and Basigin (CD147) Expression in Mice. Indian J Hematol Blood Transfus 2020; 36:711-718. [PMID: 33100715 PMCID: PMC7573055 DOI: 10.1007/s12288-020-01272-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/26/2020] [Indexed: 11/30/2022] Open
Abstract
The present study was designed to study the splenectomy induced modulation of erythrocyte turnover in mice. We have also studied the modulation of reactive oxygen species (ROS) and basigin (CD147) expression level on erythrocytes in splenectomized condition. The erythrocyte turnover was studied by a newly developed double in vivo biotinylation (DIB) technique. This technique enables to discriminate three different age (young, intermediate and old) groups of erythrocytes. The expression level of ROS and CD147 was studied by staining with CM-H2DCFDA stain and anti-mouse CD147 monocloclonal antibody followed by flow cytometry. We observed that intermediate and old age groups of erythrocytes were randomly eliminated in splenectomized condition. A marked surge in the blood reticulocyte count was observed in splenectomized mice. Splenectomy induced the level of ROS and CD147 expression on erythrocytes. The expression level of ROS was induced up to 35 days, but it reversed to basal level by 42 days indicating the emergence of refractoriness to splenectomy. The CD147 expression was significantly higher on day 7, 21 and 28 but it also normalizes on later time points. We conclude that erythrocyte turnover is significantly modulated in splenectomized mice. The enhanced level of ROS and CD147 expression may be a possible cause to increase erythrocyte removal in splenectomized mice.
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Affiliation(s)
- Nitin Bhardwaj
- Department of Zoology and Environmental Science, Gurukula Kangri Vishwavidyalaya, Haridwar, Uttarakhand 249404 India
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110067 India
| | - Ashutosh Singh
- Department of Biochemistry, University of Lucknow, Lucknow, UP 226007 India
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Serra F, Roli I, Campanelli M, Cabry F, Baschieri F, Romano F, Gelmini R. Laparoscopic splenectomy in malignancies: is safe and feasible? MINERVA CHIR 2019; 74:365-373. [PMID: 31062942 DOI: 10.23736/s0026-4733.19.07851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is considered the treatment of choice for benign hematologic diseases of the spleen. However, the role of LS in malignancies is still controversial. Technical difficulties, hemorrhagic risk, the need of pathological characterization of malignant disease, may be considered contraindications to LS in malignancies. This study aims to verify the efficacy and feasibility of LS for hematologic malignancies. METHODS One hundred and forty-five patients underwent LS for hematologic disease and were retrospectively shared in two groups: Group A (N.=83) patients with preoperative diagnosis of benign hematologic disease and Group B (N.=62) with malignancies. Bipolar spleen diameter, mean operative time, conversion rate and causes, complications and need of transfusion were evaluated. RESULTS Median splenic diameter was greater in Group B than in Group A with a statistically significant difference (P<0.005), and the number of accessory mini-laparotomies (P<0.005) and the conversion rate (P=0.024) in the group of patients with a diagnosis of malignancy were also higher. The mean operative time was 117.6 minutes in group A and 148.1 minutes in Group B (P<0.005). Besides, there were no significant differences relative to intraoperative and postoperative transfusions and the incidence of postoperative complications. No perioperative mortality occurred. CONCLUSIONS The analysis of our data highlights that LS for hematologic malignancies is effective and feasible even if it associated with higher conversion rate due to splenomegaly and difficult hilum dissection. Besides, no differences in the patient outcome were highlighted. LS may be considered a safe procedure in the treatment of haematological malignancies of the spleen.
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Affiliation(s)
- Francesco Serra
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Roli
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Michela Campanelli
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Cabry
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Baschieri
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Roberta Gelmini
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy -
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Postsplenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv): A single institutional series, comprehensive systematic review of a literature and suggested classification. Am J Surg 2018; 216:1192-1204. [DOI: 10.1016/j.amjsurg.2018.01.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
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Casaccia M, Palombo D, Fornaro R, Razzore A, Soriero D, Frascio M. Laparoscopic "double-port" splenectomy. A new minimally-invasive option in a giant spleen. Int J Surg Case Rep 2018; 51:139-142. [PMID: 30153611 PMCID: PMC6111032 DOI: 10.1016/j.ijscr.2018.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In case of massive splenomegaly, laparoscopic splenectomy (LS) becomes challenging, uncomfortable and risky both for the surgeon and for the patient. As a consequence of ongoing research to obtain efficient and cheaper "scarless surgery", single-port technique and hand-assisted devices were developed and improved in this field. PRESENTATION OF CASE We present the clinical case of a patient affected by idiopathic myelofibrosis (MF) and splenomegaly who was admitted to our Department to perform a splenectomy for a suspected 5-cm splenic lesion. DISCUSSION The splenic longitudinal diameter measured 26 cm. The patient underwent splenectomy by laparoscopy, combining a single-port access and a gel-port device. The operation was completed laparoscopically. The operating time was 220 min and the estimate blood loss was 100 ml. The patient was discharged at 11 post-operative day in overall good conditions. Upon pathological analysis the splenic lesion was a localization of diffuse large B-cell Lymphoma in the context of MF. CONCLUSION this novel "hybrid technique" of splenectomy, combining the advantages of reduced number of abdominal incisions of the single-port technique to those of the hand assistance, is feasible in massive splenomegaly with good results. Furthermore, the use of the sovrapubic retrieval incision as the introduction site for the hand assisted device is convincing, since it's useful for both tasks. Further studies with large casuistries are necessary to confirm the effectiveness of the technique.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Italy.
| | - Denise Palombo
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Italy
| | - Rosario Fornaro
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Italy
| | - Andrea Razzore
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Italy
| | - Domenico Soriero
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Italy
| | - Marco Frascio
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Italy
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Casaccia M, Stabilini C, Gianetta E, Ibatici A, Santori G. Current concepts of laparoscopic splenectomy in elective patients. World J Surg Proced 2014; 4:33-47. [DOI: 10.5412/wjsp.v4.i2.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/13/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Formerly, open splenectomy represented the conventional surgical treatment for many hematologic diseases. Currently, thanks to permanent technical development and improved skills, also laparoscopic splenectomy (LS) has become a recognized procedure in the treatment of spleen diseases, even in case of splenomegaly. A systematic review was performed with the aim of recalling the proved concepts of this surgical treatment and to browse new devices and techniques and their impact on the surgical outcome. The literature search was initially conducted in PubMed by entering general queries related to LS. The record identified through PubMed searching (n = 1599) was then screened by applying several criteria (study published in English from 1991 to 2013 with abstract available, by excluding systematic/non-systematic reviews, meta-analysis, practice guidelines, case reports, and study involving animals). The articles assessed for eligibility (n = 160) were primarily evaluated by excluding studies that did not report operative time and conversion to open surgery. For articles that treated multiport LS we included only clinical trials with patients > 20. The studies included in qualitative synthesis were 23. The search strategy carried out in PubMed does not allow to obtain an overview of the items returned by the main queries. With this aim we replicated the search in the Web of ScienceTM database, only including the studies published in English in the period 1991-2013 with no other filter/selection criteria. The full records (n = 1141) and cited references returned by Web of ScienceTM were analyzed with the visualization of similarities (VOS) mapping technique. Maps of title/abstract text corpus and bibliographic coupling of authors obtained by applying the VOS approach were presented. If in normal-size or moderately enlarged spleens the laparoscopic approach is unquestionable, in massive splenomegaly the optimal technique remain to be determined. In this setting, prospective randomized trials to compare open vs LS are needed. Between the new techniques of LS the robotic single port splenectomy has the ability to join all the positive aspects of both techniques. Data about this topic are too initial and need to be confirmed with further studies.
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Wood L, Baker PM, Martindale A, Jacobs P. Splenectomy in haematology–A 5-year single centre experience. Hematology 2013; 10:505-9. [PMID: 16321816 DOI: 10.1080/10245330500183418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To define indications and outcome in haematologic cases undergoing splenectomy. STUDY DESIGN A retrospective review of clinical records from consecutive patients having open or laparoscopic removal of the spleen in an academic centre in the private sector. Endpoints were survival, operating time, spleen size, histopathology, requirements for blood or related products complications and average costs. RESULTS In the total group (n = 69) there were two deaths. Referrals were for immune thrombocytopaenia (41%), acquired haemolytic anaemia (10%), myeloproliferative syndrome (9%), acute or chronic leukaemia (19%), lymphoma (13%) and a miscellaneous group (8%), comprising cholelithiasis, aplasia or as a diagnostic procedure for otherwise unexplained splenomegaly. An open midline approach was predicated by spleens greater than twice normal size and a history of any bleeding disorder. Here the mean operating time was 83 min (range 40-295) whereas for laparoscopy this was 251 min (range 181-272). SUMMARY Careful stratification between the two options facilitated optimum haemostasis and consequently reduced requirement for packed red cells and platelets. Neither underlying pathology nor the choice of treatment influenced morbidity or mortality. Overall local experience is consistent with published international standards of surgical practice. Outcome is directly proportional to the number of each procedure carried out by a single team, observance of consistent protocols for preoperative evaluation and standardized proactive management through the recovery period.
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Affiliation(s)
- Lucille Wood
- Constantiaberg Medi-Clinic, The Department of Haematology and Bone Marrow Transplantation Unit incorporating the Searll Laboratory for Cellular and Molecular Biology, Burnham Road, Plumstead, Cape Town, 7800, South Africa
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Yamamoto S, Tsukamoto T, Kanazawa A, Shimizu S, Morimura K, Toyokawa T, Xiang Z, Sakurai K, Fukuoka T, Yoshida K, Takii M, Inoue K. Laparoscopic splenectomy for histiocytic sarcoma of the spleen. World J Gastrointest Surg 2013; 5:129-134. [PMID: 23717746 PMCID: PMC3664293 DOI: 10.4240/wjgs.v5.i4.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/19/2013] [Accepted: 03/07/2013] [Indexed: 02/06/2023] Open
Abstract
Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged spleen. She suffered from progressive anemia and required a red blood cell transfusion once a month. Although computed tomography, ultrasonography, and magnetic resonance imaging were performed for diagnosis, a confirmed diagnosis was not obtained. Her enlarged spleen compressed her stomach, and she suffered from gastritis and a sense of gastric fullness just after meals. She underwent laparoscopic splenectomy for therapeutic and diagnostic purposes. Her post-operative course was uneventful. After surgery, her red blood cell and platelet counts increased markedly. The tumor was diagnosed as splenic histiocytic sarcoma. Post-surgical chemotherapy was not performed, and the patient died of liver failure due to liver metastasis 5 mo after surgery. Laparoscopic splenectomy is minimally invasive and useful for the relief of symptoms related to hematological disorders. However, in cases of an enlarged spleen, optimal views and working space are limited. In such cases, splenic artery ligation can markedly reduce the size of the spleen, thus facilitating the procedure. The case reported herein suggests that laparoscopic splenectomy may be useful for the treatment of splenic malignancy.
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Frasier LL, Malani PN, Diehl KM. Splenectomy in older adults: indications and clinical outcomes. Int J Hematol 2013; 97:480-4. [PMID: 23443974 DOI: 10.1007/s12185-013-1300-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 01/29/2013] [Accepted: 02/14/2013] [Indexed: 12/01/2022]
Abstract
The aim of this study was to improve the understanding of the indications and associated outcomes among older adults undergoing splenectomy. Data regarding patients of age ≥60 years treated between 1998 and 2008 were reviewed. Fifty patients (age 71.6 ± 8) were identified. Common indications for splenectomy included idiopathic thrombotic purpura (26.0 %) and lymphoma (28.0 %). Patient co-morbidities included hypertension (54 %), coronary artery disease (24 %) and diabetes mellitus (20 %). Twenty-seven patients (54 %) underwent laparoscopic surgery; 23 (46 %) had open procedures; more than half of open splenectomies were conversions from attempted laparoscopy. Mean post-operative length of stay (LOS) was 5.9 ± 5 days (range 1-21). Two patients died in hospital; an additional three died within 6 months. Five patients were discharged to an extended care facility (ECF). Three patients required readmission within 30 days. Increased age was associated with need for ECF (p = 0.01). Increasing LOS, but not age, was associated with 6-month mortality (p = 0.04). Although we noted a 10 % in hospital mortality rate, splenectomy appears to be safe for carefully selected older adults.
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Affiliation(s)
- Lane L Frasier
- University of Michigan Medical School, Ann Arbor, MI, USA
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Gelmini R, Franzoni C, Spaziani A, Patriti A, Casciola L, Saviano M. Laparoscopic splenectomy: conventional versus robotic approach--a comparative study. J Laparoendosc Adv Surg Tech A 2011; 21:393-8. [PMID: 21561335 DOI: 10.1089/lap.2010.0564] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Laparoscopic splenectomy is accepted as a safe approach in the surgical treatment of blood disorders worldwide. Compared with the laparotomic technique, it is associated with a lower risk of intraoperative bleeding, less postoperative pain, and faster discharge times. The advent of robotic surgery (RS) has changed the concept of minimally invasive surgery because, in addition to allowing a three-dimensional view, it permits greater freedom of movement and higher levels of accuracy than laparoscopic surgery (LS). The aim of this study was to comparatively evaluate whether RS presents advantages over LS in spleen surgery. METHODS In two Surgical Units with experience in laparoscopic splenectomy, over a 7-year period, two groups of 45 patients underwent LS and RS. The two groups were well matched for demographic characteristics, indications, and spleen size. RESULTS No statistically significant differences were found regarding intraoperative blood loss, conversion rate to laparotomy, food intake, drain removal, postoperative complications, and median time to discharge. On the contrary, statistically increased differences were observed in median operative time and costs. In both groups, the transfusion and mortality rate was 0%. At the 6-month follow-up no surgical complications were observed. CONCLUSIONS Although RS offers a three-dimensional view, greater freedom of movement, and higher levels of accuracy, it is associated with longer operative times and higher costs. It can consequently be concluded that with the intrinsic limits of the study design used, at the current time, RS does not have any significant advantage over LS in splenectomy.
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Affiliation(s)
- Roberta Gelmini
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy.
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10
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Abstract
Laparoscopic splenectomy (LS) has become the standard approach to splenectomy for benign and malignant hematologic diseases despite a paucity of high-level evidence. The procedure requires expertise in laparoscopic surgical techniques and meticulous dissection of the spleen. Management should include a preoperative radiologic assessment to measure splenic volume and to detect the presence of accessory splenic tissue; the patient should undergo preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections. Prophylactic antibiotics are used in the perioperative period as well as prophylactic anticoagulation therapy which may be continued long-term in high-risk patients. LS is associated with a low morbidity and mortality; when compared to laparotomy, it reduces the length of hospital stay and improves the quality of life by decreasing postoperative ileus and pain. There are a variety of laparoscopic approaches; the hand-assisted technique and newer coagulating devices have facilitated the operative technique leading to increasing acceptance of laparoscopy as the preferred approach - even in patients with malignant hematologic disease and/or massive splenomegaly.
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Affiliation(s)
- F Borie
- Service de chirurgie digestive B, CHU Carémeau, place de Pr-Debré, 30029 Nimes, France.
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11
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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: 9.8] [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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Feldman LS, Demyttenaere SV, Polyhronopoulos GN, Fried GM. Refining the Selection Criteria for Laparoscopic Versus Open Splenectomy for Splenomegaly. J Laparoendosc Adv Surg Tech A 2008; 18:13-9. [PMID: 18266568 DOI: 10.1089/lap.2007.0050] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liane S. Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sebastian V. Demyttenaere
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gerry N. Polyhronopoulos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gerald M. Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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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: 1.9] [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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Dominguez EP, Choi YU, Scott BG, Yahanda AM, Graviss EA, Sweeney JF. Impact of morbid obesity on outcome of laparoscopic splenectomy. Surg Endosc 2006; 21:422-6. [PMID: 17103267 DOI: 10.1007/s00464-006-9064-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 07/31/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because of the obesity epidemic, surgeons are operating on morbidly obese patients in increasing numbers. The aim of this study was to evaluate the impact of morbid obesity on the outcome of laparoscopic splenectomy. METHODS The study group consisted of 120 consecutive patients who underwent laparoscopic splenectomy for benign and malignant disease from March 1996 to May 2005. These patients were retrospectively divided into three groups. Group 1 had a body mass index (BMI) < 30. Group 2 patients had a BMI > or = 30 and < 40 and were considered obese. Group 3 had a BMI > or = 40 and were considered morbidly obese. Data including surgical approach (laparoscopic vs. hand-assisted), operative time, conversion rate, estimated blood loss, splenic weight, length of stay, time to tolerate a diet, pathologic diagnosis, complications, and mortality were recorded. RESULTS Complete data were available for evaluation of 112 patients of whom 73 (65%) had a BMI < 30, 32 (29%) had a BMI > or = 30 and < 40, and 7 (6%) had a BMI > or = 40. The most frequent indication for splenectomy in all three groups was idiopathic thrombocytopenic purpura (ITP). The operative times were significantly higher in patients with a BMI > 40. Conversion rates were also higher in this group, although this did not reach statistical significance. Patients with a BMI > 30 experienced similar complication rates when compared with patients with a BMI < 30. Only when patients had a BMI > 40 did they experience more complications. CONCLUSIONS Laparoscopic splenectomy was performed safely in obese patients (BMI > 30) with similar results to those of nonobese patients. Only in morbidly obese patients (BMI > 40) do outcomes and complications appear to be affected. Obesity should not be a contraindication to laparoscopic splenectomy.
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Affiliation(s)
- Edward P Dominguez
- Section of Minimally Invasive Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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15
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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: 2.8] [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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Bellows CF, Sweeney JF. Laparoscopic splenectomy: present status and future perspective. Expert Rev Med Devices 2006; 3:95-104. [PMID: 16359256 DOI: 10.1586/17434440.3.1.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laparoscopic splenectomy has become widely accepted as the approach of choice for the surgical treatment of benign and malignant hematologic diseases. Advances in technology have led to better outcomes for the procedure, and have allowed surgeons to apply the technique to disease processes that were at one time felt to be contraindications to laparoscopic splenectomy. However, challenges still remain. There is a steep learning curve associated with the procedure. The development of cost-effective laparoscopic simulators to target the skills required for laparoscopic splenectomy and other laparoscopic procedures is essential. The advent of devices which isolate and seal the large blood vessels that surround the spleen have reduced intra-operative bleeding and minimized conversions to open splenectomy. Improvements in optics and instrumentation, as well as robotic technology, will continue to define the frontier of minimally invasive surgery, and further facilitate the acceptance of laparoscopic splenectomy for the treatment of benign and malignant hematologic diseases.
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Affiliation(s)
- Charles F Bellows
- Baylor College of Medicine, Michael E DeBakey VAMC, Department of Surgery, Houston, TX 77030, USA.
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17
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Kucuk C, Sozuer E, Ok E, Altuntas F, Altunbas F, Yilmaz Z. Laparoscopic versus open splenectomy in the management of benign and malign hematologic diseases: a ten-year single-center experience. J Laparoendosc Adv Surg Tech A 2005; 15:135-9. [PMID: 15898903 DOI: 10.1089/lap.2005.15.135] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Laparoscopic splenectomy (LS) has gained wide acceptance as a safe, effective alternative to open splenectomy (OS) in the treatment of hematologic disorders. The aim of this study was to compare two cohorts of patients with similar characteristics, who underwent LS and OS in a single university teaching center. METHODS Records were reviewed from 30 patients who underwent LS for a hematologic disease and compared with a control group of 38 patients undergoing OS for hematologic disease. Demographics and outcomes were recorded. RESULTS There were no significant differences between the two groups with respect to accessory spleens, blood loss, or complication rates (P > 0.05). The operation time in the LS group was significantly longer than in the OS group (P < 0.01) and the length of hospital stay in the LS group was significantly shorter than in the OS group (P < 0.01). CONCLUSION Laparoscopic splenectomy is likely becoming the gold standard in the surgical treatment of hematologic diseases.
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Affiliation(s)
- Can Kucuk
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey.
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18
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Berman RS, Feig BW, Hunt KK, Mansfield PF, Pollock RE. Platelet kinetics and decreased transfusion requirements after splenectomy for hematologic malignancy. Ann Surg 2004; 240:852-7. [PMID: 15492568 PMCID: PMC1356492 DOI: 10.1097/01.sla.0000143303.10884.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Thrombocytopenia is a significant and morbid problem in patients with hematologic malignancy, resulting in frequent platelet transfusions and significant resource consumption. We undertook this study to determine the impact of splenectomy on transfusion requirements in patients with chronic leukemia, acute leukemia, myelodysplastic syndrome, and lymphoma. METHODS Records of 134 patients with hematologic malignancies who underwent splenectomy were reviewed. Results are reported as mean +/- standard error of the mean. RESULTS Mean preoperative (preop) platelet count was 97 +/- 8 K/microL. A significant rise in platelets, compared with preop, was observed starting on postsplenectomy day 1 (141 +/- 8 K/microL, P < 0.001 versus preop) and persisted through day 7. Counts remained significantly elevated at 3 and 6 months and years 1-5. In profoundly thrombocytopenic patients (preop levels < 20 K/microL), preop count was 11 +/- 1 K/microL. A significant postsplenectomy platelet rise persisted for at least 1 year (137 +/- 52 K/microL, P < 0.05 versus preop). An increased platelet level was observed in all hematologic subgroups; in the chronic leukemias (n = 58, P < 0.01) and in lymphoma (n = 59, P < 0.001), this reached significance. Mean platelet transfusions were significantly decreased from preop (3 months preop: 8.6 +/- 2 units) compared with postsplenectomy (3 months postsplenectomy: 5.0 +/- 1 unit, P = 0.03). This decrease was even more pronounced in profoundly thrombocytopenic patients (31.6 +/- 10.6 units preop versus 8.9 +/- 4.8 units postoperative, P = 0.01). CONCLUSIONS In the hematologic malignancies, splenectomy produces a significant and longlasting restoration of platelet levels and a resultant decrease in platelet transfusion requirements. These beneficial effects of splenectomy hold true even for the most profoundly thrombocytopenic patients.
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Affiliation(s)
- Russell S Berman
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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19
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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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20
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Walsh RM, Brody F, Brown N. Laparoscopic splenectomy for lymphoproliferative disease. Surg Endosc 2003; 18:272-5. [PMID: 14691699 DOI: 10.1007/s00464-003-8916-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2003] [Accepted: 08/21/2003] [Indexed: 12/14/2022]
Abstract
BACKGROUND Elective laparoscopic splenectomy (LS) achieves excellent results for benign hematologic diseases. The role of LS for hematologic malignancies is harder to define owing to associated splenomegaly and patient disease that may alter outcome. METHODS Retrospective review of single institution experience 1996 through 2002. To limit variability of disease processes, only patients with immune thrombocytopenic purpura (ITP) and lymphoproliferative disease (LPD) were studied. RESULTS A total of 211 LS have been performed, including 73 for LPD and 86 for ITP. Patients with LPD were significantly older, 61 vs 46 years p<0.001; male, 45 (62%) vs 33 (38%), p<0.001; and larger splenic weight, 680 vs 162 g, p<0.001. Fifty-nine patients (81%) with LPD were operated with standard LS with a conversion rate of 15%. Hand-assisted LS was performed in 14 patients (19%), and three were converted to open. Compared to ITP, patients with LPD had longer operative time, 148 vs 126 min, p<0001, and higher blood loss, 200 vs 100 cc, p = 0.004. There was one mortality (0.6%), and morbidity occurred in six patients (8%) with LPD and seven (8%) with ITP. The median length of stay was 3 days for LPD and 2 days for ITP, p = 0.03. Forty-six patients were principally operated for a diagnosis, and 27 (60%) were found to have lymphoma. CONCLUSIONS LS can be performed safely in patients with LPD, and when used judiciously with hand-assisted techniques can be performed with low conversion and morbidity rates. Splenectomy plays an important role in establishing the diagnosis of lymphoma in LPD.
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Affiliation(s)
- R M Walsh
- Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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21
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Knauer EM, Ailawadi G, Yahanda A, Obermeyer RJ, Millie MP, Ojeda H, Mulholland MW, Colletti L, Sweeney JF. 101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders. Am J Surg 2003; 186:500-4. [PMID: 14599614 DOI: 10.1016/j.amjsurg.2003.07.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is the surgical approach of choice for patients with hematologic disorders requiring splenectomy. Patients with idiopathic thrombocytopenic purpura (ITP) have normal to slightly enlarged spleens and benefit the most from LS. METHODS We reviewed the perioperative outcomes in 101 patients who underwent LS between May 1996 and December 2002. Patients were divided into three groups--ITP, other benign, and malignant hematologic disorders--and compared. RESULTS The ITP patients (n = 48) had significantly smaller spleens and operative times compared with the other groups. Splenomegaly in the other benign (n = 23) and malignant hematologic disorders (n = 30) groups was responsible for higher open conversion rates and greater need for hand-assisted laparoscopic splenectomy (HALS). CONCLUSIONS Laparoscopic splenectomy and HALS can be performed with good results for benign and malignant hematologic disorders. The benefits of HALS are similar to LS, so there should be a low threshold for HALS in patients with large spleens.
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Affiliation(s)
- Eric M Knauer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston VA Medical Center, Houston, TX, USA
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22
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Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, O'Rourke N, Nathanson L, Fielding G. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 2003; 238:235-40. [PMID: 12894017 PMCID: PMC1422687 DOI: 10.1097/01.sla.0000080826.97026.d8] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the impact of spleen weight on operative and clinical outcome in a series of 108 consecutive laparoscopic splenectomies. BACKGROUND Laparoscopic splenectomy as an alternative to open splenectomy for splenomegaly is regarded as controversial. METHODS Patients underwent laparoscopic splenectomy for a range of hematological disorders between November 1992 and February 2000. Multiple linear and logistic regression analysis were used to assess the effect of massive splenomegaly (>1000 g) on perioperative mortality and morbidity, after adjusting for the joint effects of patient age, weight, pre- and postoperative full blood counts, operating time, estimated blood loss, conversion rate, reoperation rate, and duration of hospital stay. RESULTS Massive splenomegaly was recorded in 27 of 108 (25%) cases. In this group, splenic weight ranged from 1000 to 4750 g (median, 2500 g). Patients with splenic weight >1000 g had a significantly longer median operating time (170 vs. 102 minutes, P < 0.01), conversion rate (5/27 vs. 4/81, P < 0.05), postoperative morbidity (15/27 vs. 4/81, P < 0.01), and median postoperative stay (5 vs. 3 days, P < 0.01). Multivariate analysis found splenic weight to be the most powerful predictor of morbidity (P < 0.01). Patients with splenomegaly (>1000 g) were 14 times likely to have post operative complications. One patient died 3 days after surgery, following a pulmonary embolus (spleen weight 500 g, mortality 1/108, 0.9%). CONCLUSIONS Laparoscopic splenectomy is feasible in patients with giant spleens. However, it is associated with greater morbidity, and the advantages of minimal access surgery in this subgroup of patients are not so clear.
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Affiliation(s)
- Ameet G Patel
- Departments of Surgery, Haematology, and Biostatistics, King's College Hospital, London, United
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de Wilt JHW, McCarthy WH, Thompson JF. Surgical treatment of splenic metastases in patients with melanoma. J Am Coll Surg 2003; 197:38-43. [PMID: 12831922 DOI: 10.1016/s1072-7515(03)00381-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgery is rarely undertaken for metastatic melanoma in the spleen. To identify indications for surgical treatment, results after splenectomy for metastatic melanoma were analyzed. STUDY DESIGN A retrospective study in which all patients at the Sydney Melanoma Unit recorded as having splenic metastases between January 1990 and May 2001 were identified. For those who underwent surgery, indications for splenectomy, operative complications, and outcomes were documented. RESULTS Splenectomy was performed in 15 patients, and 98 patients were treated conservatively. Indications for surgery were rupture of the spleen (n = 1), discomfort or pain (n = 7), and the spleen as an apparently solitary site of metastasis (n = 7). All seven symptomatic patients were free of pain after recovery from surgery. Postoperative morbidity occurred in two patients (14%) but there was no mortality. Median overall survival after splenectomy was 11 months, with a survival of 23 months for the subgroup of patients treated for a solitary lesion. Two patients who underwent splenectomy were disease free after more than 2 years of followup. Median overall survival of the conservatively treated patients was 4 months, which was statistically shorter than median survival of the patients who underwent splenectomy (p = 0.02). CONCLUSIONS Splenectomy can provide good palliation for symptomatic patients with melanoma metastases in the spleen. A selected group of patients with solitary splenic metastases can achieve longterm disease-free survival after splenectomy.
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Affiliation(s)
- Johannes H W de Wilt
- Sydney Melanoma Unit and The Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Australia
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24
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Ailawadi G, Yahanda A, Dimick JB, Bedi A, Mulholland MW, Colletti L, Sweeney JF. Hand-assisted laparoscopic splenectomy in patients with splenomegaly or prior upper abdominal operation. Surgery 2002; 132:689-94; discussion 694-6. [PMID: 12407354 DOI: 10.1067/msy.2002.127686] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) in patients with significant splenomegaly or prior upper abdominal operation is technically challenging with a high conversion rate to open operation. We hypothesized that hand-assisted laparoscopic splenectomy (HLS) in this setting would improve operative (OR) outcomes without impacting post-OR ileus, length of stay, morbidity, or mortality, compared with LS. METHODS All patients with splenomegaly (spleen weight > or = 500 g) or prior upper abdominal operation undergoing LS or HLS between March 1996 and June 2001 were reviewed. Nonparametric continuous variables were expressed as median and intraquartile range with statistical significance determined by Wilcoxon rank sum test. RESULTS Of 41 patients reviewed, 22 underwent HLS, whereas 19 underwent LS. Median OR time for HLS was significantly less than for LS (161 minutes vs 212 minutes, P =.004). HLS was associated with a lower conversion rate (13.6% vs 36.8%, P =.08) and blood loss (325 mL vs 550 mL, P =.18) than LS, which approached statistical significance. HLS did not increase post-OR ileus, length of stay, morbidity, or mortality. CONCLUSIONS HLS in patients with significant splenomegaly or prior upper abdominal operation significantly shortens OR time compared with LS without adversely impacting post-OR ileus, length of stay, morbidity, or mortality. In addition, HLS may be associated with a lower conversion rate and decreased blood loss.
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Affiliation(s)
- Gorav Ailawadi
- Section of General Surgery, University of Michigan Medical School, Ann Arbor, USA
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Rabban JT, Meng MV, Yeh B, Koppie T, Ferrell L, Stoller ML. Kidney morcellation in laparoscopic nephrectomy for tumor: recommendations for specimen sampling and pathologic tumor staging. Am J Surg Pathol 2001; 25:1158-66. [PMID: 11688575 DOI: 10.1097/00000478-200109000-00006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Laparoscopic nephrectomy is a novel approach for small renal tumors in selected patients; however, removal of the kidney through the small laparoscopic abdominal wall incision site requires the kidney to be morcellated into small fragments while still in situ. Morcellation presents two problems for the pathologist. First, guidelines for optimal sampling of morcellated fragments have not been described. Second, morcellation precludes complete pTNM tumor staging, in particular, tumor size, margins, and renal vein involvement. Based on our initial experience with 23 laparoscopic nephrectomies/nephroureterectomies (13 clinically suspected neoplasms, confirmed pathologically as renal cell carcinoma [RCC, n = 7], urothelial carcinoma of the renal pelvis [n = 3], angiomyolipoma [n = 1], and cystic nephroma [n = 1], and 10 clinically benign entities) and a conservative statistical model, we present a decision analysis model of various specimen sampling protocols that optimize cost, labor, or time to diagnosis (single vs sequential sampling). Using the tumor-to-kidney volume ratio (TKR), calculated from preoperative radiologic imaging and specimen gross weight, several specimen sampling algorithms were compared. For the average situation in which TKR is > or =0.15, the algorithm that most significantly optimizes cost and labor is one that initially samples 5% of the morcellated specimen. However, additional sampling may be required in one fourth of the cases. The optimal amount of sampled tissue may indeed be less than 5% because this assumes no suspicious tissue is grossly visible and in all our cases of RCC grossly visible tumor was identified. Additional nomograms for a spectrum of TKR, sampling success, and cost are presented to allow pathologists their own discretion in determining optimal sampling of the morcellated kidney. Tumor staging is severely limited by morcellation. Tumor size, renal capsule involvement, and renal vein involvement cannot be fully pathologically evaluated for RCC, whereas invasion cannot be definitively assessed for urothelial carcinoma of the renal pelvis. Knowledge of the radiologic features (lesion size, capsule, and vein involvement) is important in sampling and staging morcellated kidneys removed laparoscopically.
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Affiliation(s)
- J T Rabban
- Department of Pathology, University of California, San Francisco 94143, USA.
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Abstract
BACKGROUND Although the recent development of hand-assisted laparoscopic surgery (HALS) has made the laparoscopic retraction of large spleens feasible, the laparoscopic removal of massively enlarged spleens (>1,000 g) remains a significant problem because these spleens do not fit into endoscopic bags. Consequently, in order to remove massive spleens either a large abdominal incision or morcellation of the spleen outside of an endoscopy bag is required. METHODS Two patients, with spleens weighing 2,510 g and 1,720 g, underwent laparoscopic splenectomy using a hand port to ensure safe retraction. The massive spleen was placed into a Lahey bag that was inserted into the abdomen through the hand port site. While in the Lahey bag, the spleen was removed piecemeal through the hand port site. RESULTS Both operations were completed laparoscopically without complications. The patients were discharged on postoperative day 2 and experienced minimal morbidity. CONCLUSIONS The Lahey bag facilitates laparoscopic splenectomy for massive splenomegaly as even the most massive spleens will fit into a Lahey bag. A massive spleen may be removed piecemeal from the Lahey bag through the small hand port incision without risking a large abdominal incision, splenosis, or the insertion of a morcellator.
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Affiliation(s)
- A K Greene
- Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Cuschieri A. Role of video-laparoscopy in the staging of intra-abdominal lymphomas and gastrointestinal cancer. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:167-72. [PMID: 11398209 DOI: 10.1002/ssu.1029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is good category II/III evidence that video-laparoscopic staging is valuable in certain gastrointestinal (gastric, esophageal, pancreatic, and hepatobiliary) and intra-abdominal lymphomas, but no category I evidence (based on prospective randomized trials). The evidence available is all retrospective, but of sufficient consistency to indicate that laparoscopic staging adds to the primary (imaging) staging and often alters the clinical stage of the disease and hence the management of the individual patient. The advent of laparoscopic contact ultrasound (LCU) scanning has improved the staging accuracy for pancreatic and hepatobiliary neoplasms. The laparoscopic approach also offers a means of surgical palliation in certain patient groups. However, there are a number of unresolved issues concerning the use of video-laparoscopy. The most important concerns whether staging laparoscopy should be performed immediately before scheduled surgery or as a separate intervention. The cost-efficacy of these two management options needs to be evaluated in prospective studies. In some centres, laparoscopic staging is being conducted by gastroenterologists and hepatologists. This raises issues of safety and ability to undertake certain procedures that may be necessary during the laparoscopic staging.
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Affiliation(s)
- A Cuschieri
- Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Scotland.
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Targarona EM, Cerdán G, Gracia E, Rodríguez M, Trias M. Results of laparoscopic splenectomy for treatment of malignant conditions. HPB (Oxford) 2001; 3:251-5. [PMID: 18333026 PMCID: PMC2020637 DOI: 10.1080/136518201753335746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is widely accepted for treatment of benign diseases, but there are few reports of its use in cases of haematological malignancy. In addition, comparative studies with open operation are lacking. Malignant haematological diseases have specific clinical features-notably splenomegaly and impaired general health-which can impact on the immediate outcome after LS. The immediate outcome of LS comparing benign with malignant diagnoses has been analysed in a prospective series of 137 operations. PATIENTS AND METHODS Between February 1993 and April 2000, 137 patients with a wide range of splenic disorders received LS. Clinical data and immediate outcome were prospectively recorded,and age, diagnosis, operation time, perioperative transfusion requirement, spleen weight, conversion rate, accessory incision, hospital stay and complications were analysed. RESULTS The series included 100 benign cases and 37 suspected malignancies. In patients with malignant diseases the mean age was greater (37 years [3-85] vs 60 years [27-82], p<0.01), LS took longer (138 min [60-400] vs 161 min [75-300], p<0.05) and an accessory incision for spleen retrieval was required more frequently (18% vs 93%, p<0.01) because the spleen was larger (279 g [60-1640] vs 1210 g [248-3100], p <0.01). However, the rate of conversion to open operation (5% vs 14%), postoperative morbidity rate (13% vs 22%) and transfusion requirement (15% vs 26%) did not differ between benign and malignant cases. Hospital stay was longer in malignant cases (3.7 days [2-14] vs 5 days [2-14], p<0.05). CONCLUSION LS is a safe procedure in patients with malignant disease requiring splenectomy in spite of the longer operative time and the higher conversion rate.
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Affiliation(s)
- E M Targarona
- Service of General and Digestive Surgery, Hospital de S Pau, Autonomous University of Barcelona, Spain
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