Clinical Application of Totally Laparoscopic Splenectomy Via Anterior Approach_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YUZe-yuan , LONGBo , GUOLing-yun , LUOChang-jiang , ZHOUHui-nian ,  JIAOZuo-yi

The First Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China;

Corresponding author：

JIAOZuo-yi, Email: jiaozuoyi@163.com

Keywords：

Splenectomy; Laparoscope; Anterior approach

DOI：

10.7507/1007-9424.20160354

Video：

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Objective To investigate clinical application value of totally laparoscopic splenectomy via anterior approach. Methods The clinical data of 26 consecutive patients underwent totally laparoscopic splenectomy via anterior approach from March 2012 to June 2015 in this hospital were analyzed retrospectively. There were 11 males and 15 females. These patients included 2 cases of traumatic spleen ruptures, 4 cases of idiopathic thrombocytopenic purpuras, 1 case of hereditary spherocytosis, 3 cases of splenic cysts, 5 cases of autoimmunity hemolytic anemias, 2 cases of splenic hemangioma, 1 case of hematolymphangioma, 8 cases of cirrhosis portal hypertensions. The operative time, intraoperative bleeding, postoperative time to out-of-bed activity, the first flatus/bowel motion time, complications, and hospital stay were analyzed retrospectively. Results Twenty-six patients were successfully carried out totally laparoscopic splenectomy via anterior approach. The average operation time was 93 min (72-120 min). The average blood loss was 60 mL (10-80 mL). The postoperative time to out-of-bed activity was 24 h. The first flatus/bowel motion time was 2-3 d. The average hospital stay was 7 d (6-9 d). The postoperative pancreatic fistula (Grade A) occurred in 1 patient, who recovered well on day 6 by postoperative drainage management. After 5-32 months of following-up, all patients recovered smoothly without any long-term complications. Conclusion The preliminary results of limited cases in this study show that totally laparoscopic splenectomy via anterior approach is feasible, safe, and minimally invasive.

Citation： YUZe-yuan, LONGBo, GUOLing-yun, LUOChang-jiang, ZHOUHui-nian, JIAOZuo-yi. Clinical Application of Totally Laparoscopic Splenectomy Via Anterior Approach. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1389-1392. doi: 10.7507/1007-9424.20160354 Copy

1.	Gamme G, Birch DW, Karmali S. Minimally invasive splenectomy:an update and review. Can J Surg, 2013, 56(4):280-285.
2.	Fisichella PM, Wong YM, Pappas SG, et al. Laparoscopic splenec-tomy:perioperative management, surgical technique, and results. J Gastrointest Surg, 2014, 18(2):404-410.
3.	Katkhouda N, Hurwitz MB, Rivera RT, et al. Laparoscopic splenec-tomy:outcome and efficacy in 103 consecutive patients. Ann Surg, 1998, 228(4):568-578.
4.	Matharoo GS, Afthinos JN, Gibbs KE. Trends in splenectomy:where does laparoscopy stand? JSLS, 2014, 18(4).
5.	Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med, 1991, 20(44):2263.
6.	罗建强, 梁中骁, 黄顺荣. 腹腔镜巨脾切除贲门周围血管离断术治疗门脉高压症. 腹腔镜外科杂志, 2009, 14(12):911-912.
7.	Fan Y, Wu SD, Kong J, et al. Feasibility and safety of single-incision laparoscopic splenectomy:a systematic review. J Surg Res, 2014, 186(1):354-362.
8.	Cai YQ, Zhou J, Chen XD, et al. Laparoscopic splenectomy is an effective and safe intervention for hypersplenism secondary to liver cirrhosis. Surg Endosc, 2011, 25(12):3791-3797.
9.	Zafar H, Hameed A, Pardhan A, et al. Laparoscopic splenectomy for haematological disorder:our experience. J Pak Med Assoc, 2012, 62(10):1096-1099.
10.	Habermalz B, Sauerland S, Decker G, et al. Laparoscopic splenectomy:the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc, 2008, 22(4):821-848.
11.	陈斌. 腹腔镜脾切除治疗特发性血小板减少性紫癜20例. 中国普外基础与临床杂志, 2009, 16(10):810-811.
12.	田浪, 胡勇, 冯燮林, 等. 腹腔镜脾切除与开腹脾切除治疗肝硬变门静脉高压致脾功能亢进疗效比较的系统评价. 中国普外基础与临床杂志, 2013, 20(3):293-302.
13.	Vecchio R, Marchese S, Intagliata E, et al. Long-term results after splenectomy in adult idiopathic thrombocytopenic purpura:compa-rison between open and laparoscopic procedures. J Laparoendosc Adv Surg Tech A, 2013, 23(3):192-198.
14.	Ray U, Gupta S, Chatterjee S, et al. Laparoscopic versus open splene-ctomy in the treatment of idiopathic thrombocytopenic purpura:an Indian experience. J Indian Med Assoc, 2012, 110(12):889-893.
15.	Musallam KM, Khalife M, Sfeir PM, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg, 2013, 257(6):1116-1123.
16.	Qu Y, Xu J, Jiao C, et al. Long-term outcomes of laparoscopic splene-ctomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg, 2014, 99(3):286-290.
17.	Sharma D, Shukla VK. Laparoscopic splenectomy:16 years since Delaitre with review of current literature. Surg Laparosc Endosc Percutan Tech, 2009, 19(3):190-194.
18.	文宇, 苗雄鹰, 黄生福, 等. 腹腔镜下脾切除手术的学习曲线分析. 中南大学学报:医学版, 2013, 37(5):517-520.
19.	Fraser SA, Bergman S, Garzon J. Laparoscopic splenectomy:learning curve comparison between benign and malignant disease. Surg Innov, 2012, 19(1):27-32.
20.	张海阳, 黄建平, 钱建萍. 腹腔镜巨脾切除术. 肝胆胰外科杂志, 2005, 17(3):193-194.
21.	Lavu H. The feasibility and safety of laparoscopic splenectomy for massive splenomegaly:a comparative study. J Surg Res, 2012, 178(1):119-120.
22.	李建伟, 郑树国, 陈健, 等. 全腹腔镜巨脾和非巨脾切除的对比研究. 中国现代普通外科进展, 2010, 13(2):131-133.
23.	Wang B, Wu HS, Wang GB, et al. Laparoscopy splenectomy for massive splenomegaly. J Invest Surg, 2013, 26(3):154-157.
24.	Al-Mulhim AS. Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases. Surg Endosc, 2012, 26(11):3186-3189.
25.	Owera A, Hamade AM, Bani Hani OI, et al. Laparoscopic versus open splenectomy for massive splenomegaly:a comparative study. J Laparoendosc Adv Surg Tech A, 2006, 16(3):241-246.

1. Gamme G, Birch DW, Karmali S. Minimally invasive splenectomy:an update and review. Can J Surg, 2013, 56(4):280-285.
2. Fisichella PM, Wong YM, Pappas SG, et al. Laparoscopic splenec-tomy:perioperative management, surgical technique, and results. J Gastrointest Surg, 2014, 18(2):404-410.
3. Katkhouda N, Hurwitz MB, Rivera RT, et al. Laparoscopic splenec-tomy:outcome and efficacy in 103 consecutive patients. Ann Surg, 1998, 228(4):568-578.
4. Matharoo GS, Afthinos JN, Gibbs KE. Trends in splenectomy:where does laparoscopy stand? JSLS, 2014, 18(4).
5. Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med, 1991, 20(44):2263.
6. 罗建强, 梁中骁, 黄顺荣. 腹腔镜巨脾切除贲门周围血管离断术治疗门脉高压症. 腹腔镜外科杂志, 2009, 14(12):911-912.
7. Fan Y, Wu SD, Kong J, et al. Feasibility and safety of single-incision laparoscopic splenectomy:a systematic review. J Surg Res, 2014, 186(1):354-362.
8. Cai YQ, Zhou J, Chen XD, et al. Laparoscopic splenectomy is an effective and safe intervention for hypersplenism secondary to liver cirrhosis. Surg Endosc, 2011, 25(12):3791-3797.
9. Zafar H, Hameed A, Pardhan A, et al. Laparoscopic splenectomy for haematological disorder:our experience. J Pak Med Assoc, 2012, 62(10):1096-1099.
10. Habermalz B, Sauerland S, Decker G, et al. Laparoscopic splenectomy:the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc, 2008, 22(4):821-848.
11. 陈斌. 腹腔镜脾切除治疗特发性血小板减少性紫癜20例. 中国普外基础与临床杂志, 2009, 16(10):810-811.
12. 田浪, 胡勇, 冯燮林, 等. 腹腔镜脾切除与开腹脾切除治疗肝硬变门静脉高压致脾功能亢进疗效比较的系统评价. 中国普外基础与临床杂志, 2013, 20(3):293-302.
13. Vecchio R, Marchese S, Intagliata E, et al. Long-term results after splenectomy in adult idiopathic thrombocytopenic purpura:compa-rison between open and laparoscopic procedures. J Laparoendosc Adv Surg Tech A, 2013, 23(3):192-198.
14. Ray U, Gupta S, Chatterjee S, et al. Laparoscopic versus open splene-ctomy in the treatment of idiopathic thrombocytopenic purpura:an Indian experience. J Indian Med Assoc, 2012, 110(12):889-893.
15. Musallam KM, Khalife M, Sfeir PM, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg, 2013, 257(6):1116-1123.
16. Qu Y, Xu J, Jiao C, et al. Long-term outcomes of laparoscopic splene-ctomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg, 2014, 99(3):286-290.
17. Sharma D, Shukla VK. Laparoscopic splenectomy:16 years since Delaitre with review of current literature. Surg Laparosc Endosc Percutan Tech, 2009, 19(3):190-194.
18. 文宇, 苗雄鹰, 黄生福, 等. 腹腔镜下脾切除手术的学习曲线分析. 中南大学学报:医学版, 2013, 37(5):517-520.
19. Fraser SA, Bergman S, Garzon J. Laparoscopic splenectomy:learning curve comparison between benign and malignant disease. Surg Innov, 2012, 19(1):27-32.
20. 张海阳, 黄建平, 钱建萍. 腹腔镜巨脾切除术. 肝胆胰外科杂志, 2005, 17(3):193-194.
21. Lavu H. The feasibility and safety of laparoscopic splenectomy for massive splenomegaly:a comparative study. J Surg Res, 2012, 178(1):119-120.
22. 李建伟, 郑树国, 陈健, 等. 全腹腔镜巨脾和非巨脾切除的对比研究. 中国现代普通外科进展, 2010, 13(2):131-133.
23. Wang B, Wu HS, Wang GB, et al. Laparoscopy splenectomy for massive splenomegaly. J Invest Surg, 2013, 26(3):154-157.
24. Al-Mulhim AS. Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases. Surg Endosc, 2012, 26(11):3186-3189.
25. Owera A, Hamade AM, Bani Hani OI, et al. Laparoscopic versus open splenectomy for massive splenomegaly:a comparative study. J Laparoendosc Adv Surg Tech A, 2006, 16(3):241-246.

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Clinical Application of Totally Laparoscopic Splenectomy Via Anterior Approach

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