Laparoscopic splenectomy: a selected retrospective review

Previous investigators have suggested that laparoscopic splenectomy should be the procedure of choice for the treatment of benign hematologic disorders unresponsive to medical therapy. To evaluate the safety and utility of laparoscopic splenectomy for a variety of splenic disorders, we reviewed our collective experience at 2 institutions. We studied our 8-year experience by retrospective chart review. Patient demographic data, splenic pathology, intraoperative events, concomitant procedures, and all adverse perioperative events were recorded. A total of 131 patients had laparoscopic splenectomy, and there were 8 conversions to open surgery. Pathology included 63 with idiopathic thrombocytopenic purpura (ITP), 23 malignancies, 12 thrombotic thrombocytopenic purpura (TTP), 10 autoimmune hemolytic anemia (AIHA), and 23 others. Accessory spleens were noted in 21 patients (16%). Concomitant surgical procedures included 12 hepatic biopsies, 4 distal pancreatectomies, 4 cholecystectomies, and 7 others. Mean operative time was 170 minutes. There were 16 major complications in 16 patients and 2 deaths. Median postoperative length of stay was 3 days. Conversions, due mostly to bleeding, are related to splenic pathology and medical comorbidity and are not temporally related to surgical experience (learning curve). The morbidity, mortality, and conversion rates were low. Laparoscopic splenectomy permits an appropriate abdominal exploration and is associated with a short hospital stay. It is the procedure of choice for most indications for splenectomy.     

腹腔镜脾切除术32例报告

目的探讨腹腔镜脾切除术（laparoscopic splenectomy，LS）的可行性。方法我院1999年6月-2005年12月行LS32例，超声刀游离脾周韧带，血管切割缝合器离断脾蒂，脾脏装入塑料袋剪碎取出。结果LS成功29例，手术时间60-270min，平均100min；术中出血量30-1000ml，平均230ml。术后住院3—7d，平均5d，无术后并发症。3例中转开腹，1例为脾蒂出血，1例为胃短血管出血，1例为脾周围炎粘连紧密出血。22例特发性血小板减少性紫癜中18例血小板恢复正常，4例术后无升高。2例溶血性贫血术后血红蛋白升高。4例肝炎后肝硬化合并脾功能亢进者术后血小板恢复正常。结论腹腔镜脾切除术安全可行．尤其适合于血液系统疾病中须行脾切除者及脾脏本身病变者。     

Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases

The role of laparoscopic techniques in pancreatic surgery is still controversial especially regarding to exocrine malignancies. Operative time, conversion rate, adequacy of dissection, and morbidity do represent factors of major concern. Whereas laparoscopic resection of left sided pancreatic lesions requires no anastomosis and therefore has gained worldwide acceptance over the last years, excision of cephalic lesions by mimimal access has little place in surgeons' practice because of its technical complexity and duration of surgery. This study was designed to assess the feasibility and results of laparoscopic pancreaticoduodenectomy for neoplasms of the pancreatic head, analyzing steps of learning curve, conversion rate, and short-term outcomes. From August 2002 to December 2006, 19 patients affected by pancreatic neoplasm of the head were approached by minimally invasive technique. A video-assisted procedure with pancreaticoduodenal resection and anastomoses fashioned through a midline minilaparotomy of 7 cm was achieved in 7 patients. Conversion to laparotomy was required in 6 patients, in 3 for bleeding and in 3 for difficulties in dissection. Cephalic pancreatoduodenectomy was achieved by thorough intracorporeal technique in 6 patients. Mortality was nil. Oncologic principles with adequate lymphadenectomy and resection margins were respected and short-term outcomes and mean survival were quite acceptable and equal to those of conventional surgery.     

腹腔镜脾切除术65例临床研究

目的探讨腹腔镜脾切除术的手术技巧、影响因素及效果。方法回顾性分析本院2003年8月至2008年9月65例腹腔镜脾切除术的临床资料。结果65例中63例顺利完成腹腔镜脾切除术,2例腹腔镜脾切除取出脾脏后脾窝渗血中转小切口开腹脾窝止血,腹腔镜手术成功率达96．9％。手术时间50～180min,平均90min。术中出血量10～600ml,平均60ml。术中切除副脾14个,同时行胆囊切除3例,肝活检术4例。全组术后6～12h拔除胃管、尿管并下床活动,12～24h恢复进食。无并发症发生,无手术死亡,平均住院时间6．2d。结论只要熟练掌握腹腔镜技巧,腹腔镜脾切除术是一种安全可行的微创手术方式,值得临床推广。术中体位的选择,脾周韧带的分离,脾蒂的处理是手术成功的关键因素。     

Laparoscopic distal pancreatectomy: a retrospective review of 14 cases

Although the role of minimally invasive techniques in pancreatic surgery remains controversial, resection of the left pancreas for benign or endocrine lesions has been universally adopted as a routine technique over the last few years. This study was undertaken to assess feasibility and safety of minimal access resections of distal pancreas in benign, endocrine, and malignant diseases. Operative time, conversion rate, adequacy of dissection, respect for oncologic principles, morbidity rate, and short-term outcomes were analyzed. From the years 2002 to 2007, 14 patients affected by pancreatic neoplasm of body/tail region were approached by minimally invasive technique. Nine patients were affected by malignant neoplasms and distal splenopancreatectomy was successfully achieved by laparoscopy in 6. Five patients were affected by endocrine neoplasms; distal pancreatectomy with preservation of spleen and splenic vessels was achieved laparoscopically in 3, whereas 2 needed conversion to laparotomy. Four patients developed pancreatic leak after transection by linear cutting stapler plus oversewing, whereas no leak was observed within 30 days from surgery after transection by linear stapler with Seamguard reinforcement of the staple line (P<0.05 with Fisher exact test).     

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目的探讨腹腔镜脾切除术(laparoscopic splenectomy，LS)和腹腔镜辅助脾切除术(laparoscopic assisted splenectomy，LAS)的优缺点。方法1994～2003年共实施脾切除术43例，其中采用LAS行脾切除术13例，完全在腹腔镜下行脾切除术30例，切除副牌6例，4例同时行腹腔镜胆囊切除术。结果手术均获成功，LS术后切口感染1例，并发DIC 1例，平均手术时间160min，术中失血平均120mL，术后平均住院5．4d。LAS平均手术时间132min，术中平均失血90mL，术后平均住院8．6d。结论LS和LAS均安全可行，LAS手术时间短，术中出血少，但病人住院时间长。LS费时费事，术中出血多。     

Rhinoplasty for African American patients: a retrospective review of 75 cases

OBJECTIVE: To determine satisfaction, change in self-esteem, and maintenance of ethnic characteristics in African American patients after rhinoplasty. Patients African American male (n = 21) and female (n = 54) patients aged 14 through 58 years (mean, 33.8 years) who underwent rhinoplasty. METHODS: Open structure rhinoplasty, using the 3-tiered approach, was performed on all 75 patients. An anonymous questionnaire addressed postoperative patient satisfaction, maintenance of ethnic characteristics, self-esteem, and nasofacial harmony. The rate of complications was determined by medical record review. RESULTS: On a scale of 1 to 5 (1, no change; 5, complete change), patients reported a significant degree of preservation of ethnic characteristics (mean, 2.3), high self-esteem (mean, 4.3), and very high satisfaction (mean, 4.6) and facial harmony (mean, 4.3) postoperatively (P < .001 for all). The overall complication rate was 2.7%. CONCLUSION: In African American patients, 3-tiered open structure rhinoplasty yields high patient satisfaction with a minimal rate of major complications.     

腹腔镜脾切除术16例报告

目的:总结腹腔镜脾切除术的手术经验.方法:回顾分析2004~2010年为16例患者施行腹腔镜脾切除术的临床资料.患者取半右侧卧位,术中可灵活调整;用钝头器械显露术野,游离脾周韧带、处理脾蒂时灵活应用多种器械,用宫腔吸引刮匙协助取出标本.结果:14例手术获得成功,2例中转开腹,手术时间平均(124±52) min,术中出...     

Laparoscopic splenectomy: analysis of 60 consecutive cases

The purpose of the study was to analyze the results of 60 patients who were candidates for laparoscopic splenectomy. Over the period from May 1994 to May 2001, 60 patients were candidates for splenectomy. Laparoscopy was contraindicated in 3 cases because of ASA III and marked splenomegaly (2 cases) and previous gastric resection (1 case). The procedure was indicated for benign disease in 38 cases and for malignant disease in the remainder. Fifty-three procedures were completed laparoscopically (92.9%). Conversion proved necessary in 4 patients (6.7%) due to large incisional hernia, perisplenic abscess, bleeding of major splenic vessels at the hilum and marked splenomegaly (2 cases of lymphoma). The mean operative time was 200 min for the malignancies and 110 min for the benign conditions (P < 0.05). Major morbidity occurred in 5 cases (8.7%). No deaths were registered. The mean postoperative hospital stay was 7.5 days for patients with malignancies and 5.2 days for patients with benign disease (P < 0.05). Laparoscopic splenectomy was safe and effective in patients with benign disease, even in cases of marked splenomegaly. The morbidity rate was significantly higher in lymphoma patients than in patients with benign haematological disorders.     

Laparoscopic treatment of sigmoid diverticulitis: a retrospective review of 103 cases

Background: Laparoscopic treatment of sigmoid diverticulitis is commonly accepted in Hinchey cases I and II, whereas it is debated in the case of purulent peritonitis, and not indicated for fecal peritonitis.Methods: A single-center experience of 103 patients treated for Hinchey I–III sigmoid diverticulitis was reviewed. One-stage laparoscopic resection and primary anastomosis constituted the planned procedure. Abscesses in patients with Hinchey IIa were drained percutaneously before surgery. Patients with Hinchey III underwent surgery in emergency. A four-trocar approach with left iliac fossa minilaparotomy was used. Fistulas were treated laparoscopically with Harmonic Scalpel dissection.Results: Laparoscopic treatment was successfully completed for 100 patients. Intraoperative complications occurred in 2.9% of the cases. Postoperative procedure-related morbidity was 8%, occurring mainly in Hinchey I patients. A longer hospital stay was recorded among Hinchey IIb patients treated for colovescical fistula. No mortality was observed.Conclusions: Laparoscopic surgery for sigmoid diverticulitis in experienced hands can be a safe and effective gold standard procedure also for patients with fistula or purulent peritonitis.     

腹腔镜脾切除41例临床分析

目的 探讨腹腔镜脾切除术的安全性及临床效果。方法 回顾性分析41例腹腔镜脾切除术病例(包括10例肝硬化及17例特发性血小板减少性紫癜)的临床资料。结果 41例有2例中转开腹，39例成功完成腹腔镜切脾。该39例的平均手术时间为238min、术中失血318ml、粉碎脾脏重量389g，术后胃肠蠕动恢复时间为12～24h，平均住院时间为4d。发生并发症3例，1例术后腹腔内出血、1例皮下气肿、1例腹壁静脉刺破出血。结论 在经过选择的患者腹腔镜脾切除术是安全的，尤其适用于血液系统疾病中需行脾切除者及脾脏本身病变者。     

腹腔镜脾切除术100例

目的 总结8年多来行腹腔镜脾切除术（LS）的临床经验，探讨LS的安全性和有效性。方法 从1996年4月至2004年11月连续进行了100例15，94例为原发性和继发性脾功能亢进，6例为其它脾疾病，其中34例为巨脾。结果 100例15全部完成，1例术后5h需作小切口开腹止血，2例术后需再次腹腔镜探查和清除脾窝积血。平均手术时间2．3h，平均失血160ml。平均术后住院6d。结论 15安全、有效、切实可行，适用于有脾切除指征的原发性和继发性脾功能亢进或其它脾疾病。     

腹腔镜小儿脾切除术(附7例报告)

目的探讨腹腔镜在小儿脾切除中的应用.方法回顾性分析我院2003年10月～2005年3月腹腔镜小儿脾切除7例的临床资料,其中特发性血小板减少性紫癜5例,遗传性球形红细胞增多症1例,脾血管瘤1例.结果7例手术经过均顺利,无中转开腹手术,切除脾脏时间45～90 min,平均60 min.术中出血10～50 ml,平均23 ml.术后24 h内恢复胃肠蠕动,次日恢复饮食和下床活动,住院时间4～14 d,平均7 d.7例随访2～6个月,平均4.8月,恢复良好.结论腹腔镜下小儿脾切除术安全可行,具有创伤小、出血少、恢复快等优点.     

复杂性脾切除102例回顾性分析

目的 总结复杂性脾切除的治疗经验。方法 对1998年1月至2008年1月中南大学湘雅医院收治的102例复杂性脾切除病例进行回顾性分析。结果 病人均痊愈出院,无手术死亡及胰漏和胃、结肠损伤。其中29例出现术后并发症：腹腔内出血4例;肺部并发症13例,其中8例左胸腔积液病人有7例合并左膈下脓肿;脾静脉栓塞性静脉炎6例;大量腹水6例。分别经再次手术或保守治疗后痊愈。结论 完善的术前评估,规范的手术操作,正确的脾周粘连的解剖分离及脾蒂的处理,是确保复杂性脾切除安全的关键。     

Laparoscopic splenectomy: a personal series of 140 consecutive cases

Introduction

Laparoscopic splenectomy has emerged as a safe and effective treatment for a variety of haematological conditions. The objective was to review the results from a large personal series from the perspective of outcomes according to operative time, conversion to open operation, complications and mortality. The application of laparoscopic splenectomy to cases of splenomegaly without hand assistance is examined.

Patients and Methods

A retrospective review of 140 patients undergoing laparoscopic splenectomy at a single university hospital by one surgeon during 1994-2006. Case notes were reviewed and data collected on operative time, conversion to open procedure, morbidity and mortality. Particular reference was made towards the results of cases of splenomegaly.

Results

In total 140 laparoscopic splenectomies were performed with a complication rate of 15% and no mortality. The median operative time was 100 min and conversion to open procedure was necessary in 2.1%. Conversion for cases of splenomegaly was only 5.7%. The median hospital stay was 3 days.

Conclusions

Laparoscopic splenectomy is a safe procedure with acceptable morbidity. A laparoscopic approach for splenomegaly is feasible.     

Laparoscopic appendectomies: retrospective study of 2074 cases

PURPOSE: To determine feasibility and safety of laparoscopic appendectomy (LA). PATIENTS: From January 1991 to June 2006, 2209 consecutive patients underwent appendectomy; for 2074 patients, appendectomy was performed laparoscopically. One thousand and fifty (53%) were women; mean age was 30.8 (11 to 96) years. Mean body mass index was 23.6 (18 to 58 kg/m2). Mean American Society of Anesthesiology score was 1.3 (I to III). RESULTS: Mean operating time was 52 minutes (15 to 200). Conversion to open appendectomy occurred for 84 patients (3.6%) mainly for acute or generalized peritonitis, abscess, or adhesion. Mean hospital stay was 3.75 (1 to 27) days. There was no mortality. Morbidity occurred in 4.5% of the patients: parietal (1.15%), peritoneal complications (1.1%), and others (2.25%). Additional interventions were required for 30 patients (1.5%) primarily for residual abscesses. In this study, 10.9% (n=226) of the specimens were considered normal by the pathologist. In 3.9% (77 cases), laparoscopy did not find any cause for nonspecific abdominal pain. In these cases, appendix was not removed. CONCLUSIONS: LA is technically feasible and safe. Diagnostic laparoscopy is recommended in cases suspicious for acute appendicitis. Laparoscopy permits a complete exploration of the abdominal cavity, helps to localize the appendix, allows for the eliminations of other diagnoses when the appendix is normal, and to facilitate a better peritoneal lavage in case of peritonitis. It is recommended to perform LA routinely in young women and obese. Although advantages of LA still need to be evaluated, in view of the excellent results, we have decided to perform it routinely. We also recommend not removing macroscopically normal appendices discovered during diagnostic laparoscopy for abdominal pain of unexplained origin.     

Laparoscopic vs open gastrectomy. A retrospective review

BACKGROUND: The totally laparoscopic approach to partial gastrectomy had not been compared previously with results of the open technique. This study compares the results of a series of laparoscopic cases with matched open cases. METHODS: A retrospective case-matched study was performed in 36 patients (18 laparoscopic surgeries, 18 open surgeries). Each laparoscopic case was matched for patient age and indication for surgery. The intraoperative and postoperative details of the two groups were compared. RESULTS: Laparoscopic surgery resulted in less blood loss, although operative time was increased. Nasogastric tubes were less likely to be used after laparoscopic surgery, and patients in the laparoscopic group had an earlier return to normal bowel function than those in the open group. Length of hospital stay was 2 days shorter in the laparoscopic group. CONCLUSIONS: The totally laparoscopic approach to partial gastrectomy is an excellent alternative to the more traditional open approach. It results in a more rapid return of intestinal function and a shorter hospital stay.     

腹腔镜脾切除断流术3例报告

目的:比较手助腹腔镜脾切除断流术与完全腹腔镜脾切除断流术的治疗效果。方法:回顾分析2008年1月至2009年2月我院行腹腔镜脾切除断流术3例患者的临床资料。结果:手助腹腔镜脾切除断流术手术时间短(平均185min),术中出血量较多(平均860ml)。完全腹腔镜脾切除断流术手术时间长(245min),术中出血量较少(550ml)。结论:手助腹腔镜脾切除断流术操作较方便,适用于脾脏体积较大,脾门血管处理困难者。完全腹腔镜脾切除断流术创伤小,术中出血少,适用于脾脏体积小,胰尾细长,脾门血管易处理者。     

Laparoscopic colon resections: a five-year retrospective review

In recent years, laparoscopic surgery has become a matter of growing interest. It has been shown that laparoscopic colectomy is well tolerated and safe for benign disease. However, there is some uncertainty about using this method for malignant disease when curative resection is the aim. These uncertainties mainly consist of spread of cancer to port site, long-term survival, and adequacy of resection. The majority of laparoscopic colectomies are technically assisted procedures in which anastomosis is performed outside the abdomen. However, some surgeons are now performing this surgery totally laparoscopically with the anastomosis performed inside the abdomen. Laparoscopic colectomy is currently practiced with great frequency by general surgeons. Its performance requires a steep learning curve and a large number of cases to obtain proficiency. The indications for laparoscopic colectomy are different from one institution to another. In some institutions all patients with colorectal disease are candidates for laparoscopic colectomy and in others it may be limited to benign disease only. The purpose of this review is to analyze all laparoscopic colectomies performed at our medical center since 1992. We conducted a retrospective chart review of both hospital and clinic charts of patients who underwent colectomies at our hospital. A total of 338 patient charts were reviewed. In a comparison of both laparoscopic (n = 285) and converted (n = 53) methods, the age and operative time were about the same. Age average and operating room time average were similar for both groups. With laparoscopy, there was a 3-day drop in length of hospital stay as well as a 1-day-earlier regaining of bowel function. Hospital cost dropped 5000 dollars average for the laparoscopic colectomy. The conversion rate at our center was 15 per cent. Complication rates were lower in the laparoscopic group. Recurrence of cancer at the port site (0.7%) was no higher than in the converted group (incisional recurrence, 1.8%). We conclude that laparoscopic colectomy does show an improvement in return of bowel function, hospital cost, and shorter hospital stay. Long-term follow-up will be necessary to determine the effectiveness of laparoscopic colon resection for colorectal cancer.     

Laparoscopic splenectomy

PURPOSE: To study the safety and efficacy of laparoscopic splenectomy (LS) in patients with hematologic disorders requiring surgical intervention. PATIENTS AND METHODS: A series of 103 consecutive adult patients underwent LS between 1992 and 1997 at our teaching hospital. Data were collected prospectively. The indications for splenectomy included idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis, autoimmune hemolytic anemia, and thrombotic thrombocytopenic purpura. RESULTS: The mean spleen size was 14 cm (range 8.5-24 cm) and the mean weight was 263 g (range 40-210 g). Accessory spleens were detected in 12 patients with ITP and 17 patients in the study overall. In 12 patients, LS was combined with a laparoscopic cholecystectomy for gallstones. There were four conversions to open splenectomy, all for hemorrhage and all occurred in the first 50 patients. We have not converted a single patient in the last 2 years. The mean operative time was 161 minutes and was greater in the first 10 cases than the last 10. There were no deaths. Postoperative complications occurred in six patients, one necessitating a second procedure for a small-bowel obstruction. The average length of stay in the hospital was 2.5 days. After surgery, thrombocytopenia resolved in 84% of patients with ITP and anemia resolved in 92% of the patients with hereditary spherocytosis. After a mean follow-up of 38 months (range 2-565 months), four patients (6%) showed a relapse of ITP, three within 12 months of surgery. CONCLUSIONS: Laparoscopic splenectomy can be performed safely and effectively in a teaching institution. LS in comparison with open surgery offers the same efficacy in the control of hematologic disease with the additional benefits of a minimally invasive approach. Laparoscopic splenectomy should therefore be considered the technique of choice and should prompt earlier consideration of surgery for patients with selected hematologic disorders.