Laparoscopic-assisted splenectomy using a hand-access port

Summary

Advanced laparoscopic procedures, such as laparoscopic splenectomy (LS) are well described, but are generally not used outside units with a special interest in laparoscopic surgery. This particularly applies to LS, because of difficulties controlling the splenic pedicle and removing the spleen when completing the procedure. We describe five prospective cases of laparoscopic-assisted splenectomy (LAS) for idiopathic thrombocytopaenic purpura (ITP), using a new, specialised port which allows repeated insertion and removal of the surgeon's hand into the abdomen without loss of pneumoperitoneum. Spleens were removed intact through the hand-access port. No patient developed any respiratory or other complications. Oral fluids were tolerated at a mean of 1.0 ± 0.0 days and oral diet was tolerated at 1.4 ± 0.5 days post-operatively. Patients were discharged from hospital 3.2 ± 1.9 days post-operatively. LAS appears to offer the benefits of minimal hospital stay and analgesia requirements which have previously been associated with LS. Additional benefits, in comparison with LS, include increased tactile and retractile ability, easier control of the splenic pedicle, removal of an intact specimen for histological analysis and possibly easier location of ectopic splenic tissue. This novel device may facilitate minimally-invasive splenectomy outside specialised laparoscopic units.

Keywords:

• splenectomy
• laparoscopy
• hand-access
• laparoscopic-assisted