| Abstrakt: |
Since introduction of stapling instruments, which allow a safe hemostasis of hilar spleen vessels, the advantages of laparoscopic procedures are as well available for the laparoscopic splenectomy, like atraumatic dissection, reduced hospital stay, less bleeding and therefore less necessity of blood transfusion, and reduced analgetic consume. Laparoscopic splenectomy causes a lower morbidity comparing to open conventional splenectomy. Frequent indications for elective splenectomy are immune thrombocytopenic purpura, spherocytosis, Non Hodgkin Lymphoma and Hodgkin's disease. Limiting factors to laparoscopic splenectomy may be the size of spleen, concomiting diseases as portal hypertension and adhesions in upper left abdomen. To remove a big sized spleen we placed it within a large specimen retrival bag, which was partly delivered through a port in the left flank to allow digital morcellation of the spleen and piecemal removal. Eight females and fifteen males with a median age of 45 years (16-73) underwent splenectomy of immune thrombocytopenic purpura (14), spherocytosis (2), Non Hodgkin Lymphoma (5), Hodgkin's disease (1) and hair cell leukemia (1) with a spleen weight of 985 grams. The median operating time was 94 min (40-165) and median blood loss was 214 ml (50-400). Accessory spleens were removed in two cases. The median postoperative hospital stay was 5.6 days (3-10). The only complication was a parechymatous bleeding which needed conversion to open splenectomy. With careful selection of patients, laparoscopic splenectomy can be safely performed on normal and even enlarged spleens. The lateral approach is safe and offers excellent visualization of the splenic vessels, pancreas, and accessory spleens. |
