Hand Assisted Laparoscopic Splenectomy Is the Superior Approach in Spleens Over 20cm in Length

We report our experience with the Hand Assisted Laparoscopic Splenectomy (HALS) technique and attempt to answer the question of which spleens benefit from HALS. Initial problems with complication rates in laparoscopic splenectomy for splenomegaly have now been refuted. Critics are still concerned with the longer operative times and conversion rates of HALS compared to open procedure. Questions remain regarding which spleen sizes would benefit from HALS. Our high single center volume of HALS in Spleens over 17cm allowed us to address these questions and concerns.

217 Splenectomies (1988 – 2007) at five Vancouver hospitals were reviewed. Splenectomies without greatest dimension on whole pathologic specimen or preoperative imaging were excluded from analysis. Student t-test and chi squared statistical analysis was performed.

156 splenectomies were performed laparoscopically. 22 spleens over 20cm were removed laparoscopically (20 HALS) and 18 spleens 17-20cm (7 HALS). Conversion rates using the HALS technique in spleens over 20cm was no different than conversion rates in laparoscopic splenectomies (LS) under 17cm (6 vs. 5%, p=.917). Estimated blood loss (375cc vs. 935cc, p=0.08) and transfusion rates (0 +/- 0 vs. 0 +/-1.7 units, p=0.06) were less in HALS than open splenectomy (OS) in spleens over 20cm, hospital Stay (4.2 vs. 8.9 days, p=0.001) was significantly less. Operative time for HALS in spleens over 20cm was longer than OS (162 vs. 114 min, p=0.003) and slightly greater than 27 minute difference seen between LS and OS in under 17cm spleens. Complication rates with spleens over 20 cm were equal between techniques (6/20 HALS vs. 6/18 open). In spleens 17-20cm, HALS had more complications compared to LS (5/7 vs. 1/10, p= .035) but had no significant difference in terms of length of OR, hospital stay or blood loss.

With equal complication rates, shorter hospital stay and evidence that HALS can be performed without open conversion; patients should be offered HALS in spleens over 20cm.

Session: Podium Presentation

Program Number: S089

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