Published online Jul 28, 2014. doi: 10.5412/wjsp.v4.i2.33
Revised: May 13, 2014
Accepted: June 20, 2014
Published online: July 28, 2014
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.
Core tip: Laparoscopic splenectomy (LS) has progressively become the “gold standard” for the surgical treatment of benign hematologic diseases, regardless of the presence or absence of splenomegaly. The majority of previous published data reflects a substantial recognition of the laparoscopic method, although several areas still remain controversial. This review aims to update the current procedures and emerging technologies concerning minimally invasive splenectomy. The main indications and concerns for LS, as well as pre- and intraoperative potential problems in case of massive splenomegaly are reviewed. An evaluation of the techniques and clinical results of multiport laparoscopic splenectomy, hand-assisted laparoscopic splenectomy, robotic splenectomy, and single-port splenectomy is carried out. Moreover, postoperative outcomes of LS are examined, together with the procedure-specific complications.