Noeline Rajarajan, Julie Pepe, Paula Veldhuis, Sebastian De La Fuente. Florida Hospital Orlando
Introduction: Laparoscopic total splenectomy continues to be the operation of choice for lesions of the spleen. Total removal of the spleen, however, can result in severe early and late complications. Preservation of splenic parenchyma has been increasingly desired particularly when research has shown that only 20-30 percent is required to fulfill its immunological function and prevent the complications associated with asplenia. Laparoscopic partial splenectomy (LPS) continues to remain a marginally performed procedure and, despite its perceived benefits, the literature is still scare. In this study, we reviewed the current literature and discuss the feasibility of partial laparoscopic and robotic splenectomies.
Methods: A literature search was conducted on August 2017 for LPS using PubMed, Ovid, Clinical Key and Cochrane Library. The results were limited to material published from 2010-present, case reviews and studies which contained 2 or more patients, patients > 13 years old. Demographic data, pathology of lesion, surgical technique, estimated blood loss, blood transfusion requirement, conversion rates and complications of surgery were extracted.
Results: From the 28 publications that were retrieved after review, only 9 fulfilled the criteria for LPS. The total number of patients who underwent laparoscopic partial splenectomy were 85 (39 males and 46 females). The main pathologies encountered included cysts (n= 24) hemangiomas (n=21), and trauma (n=21). The remaining etiologies comprised lymphangiomas, hamartomas, metastasis, metaplasia and an abscess. The mean operative time for a LPS was 144 minutes with documented times ranging from 80 to 226 minutes. Average blood loss in the LPS group was 243 cc (elective cases 274 cc vs. emergency cases 174 cc). Despite this blood loss only 6% of elective cases required blood transfusion (4/60). Complications were seen in 16% of patients, 7% had fluid, 9% included atelectasis in 2 patients, one patient who developed a pulmonary embolism and one patient developed a venous thrombosis. Conversion to total laparoscopic splenectomy was 6% (5% in the elective LPS group and 9.5% in the emergency group). There was only patient converted to an open approach.
Conclusion: Minimally invasive partial splenectomy is a safe surgical procedure in both elective and emergency settings in selected patients and should be restricted to benign etiologies. LPS allows for preservation of the spleen with acceptable post-operative complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95714
Program Number: P456
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster