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.	羅建強, 梁中驍, 黃順榮. 腹腔鏡巨脾切除賁門周圍血管離斷術治療門脈高壓癥. 腹腔鏡外科雜志, 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.	陳斌. 腹腔鏡脾切除治療特發性血小板減少性紫癜20例. 中國普外基礎與臨床雜志, 2009, 16(10):810-811.
12.	田浪, 胡勇, 馮燮林, 等. 腹腔鏡脾切除與開腹脾切除治療肝硬變門靜脈高壓致脾功能亢進療效比較的系統評價. 中國普外基礎與臨床雜志, 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, 苗雄鷹, 黃生福, 等. 腹腔鏡下脾切除手術的學習曲線分析. 中南大學學報:醫學版, 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.	張海陽, 黃建平, 錢建萍. 腹腔鏡巨脾切除術. 肝膽胰外科雜志, 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.	李建偉, 鄭樹國, 陳健, 等. 全腹腔鏡巨脾和非巨脾切除的對比研究. 中國現代普通外科進展, 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. 羅建強, 梁中驍, 黃順榮. 腹腔鏡巨脾切除賁門周圍血管離斷術治療門脈高壓癥. 腹腔鏡外科雜志, 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. 陳斌. 腹腔鏡脾切除治療特發性血小板減少性紫癜20例. 中國普外基礎與臨床雜志, 2009, 16(10):810-811.
12. 田浪, 胡勇, 馮燮林, 等. 腹腔鏡脾切除與開腹脾切除治療肝硬變門靜脈高壓致脾功能亢進療效比較的系統評價. 中國普外基礎與臨床雜志, 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, 苗雄鷹, 黃生福, 等. 腹腔鏡下脾切除手術的學習曲線分析. 中南大學學報:醫學版, 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. 張海陽, 黃建平, 錢建萍. 腹腔鏡巨脾切除術. 肝膽胰外科雜志, 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. 李建偉, 鄭樹國, 陳健, 等. 全腹腔鏡巨脾和非巨脾切除的對比研究. 中國現代普通外科進展, 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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