Laparoscopic splenectomy for malignant diseases

A variety of malignant diseases involving the spleen, both primary and metastatic, may require splenectomy for diagnosis or therapeutic reasons. The role of minimally invasive surgery in the management of malignant diseases involving the spleen is not well defined because of a lack of reported experience with laparoscopic splenectomy in this group. A reluctance to perform laparoscopic splenectomy in these patients may be explained by the technical and oncological challenges that often accompany malignant splenic diseases such as splenomegaly, perisplenitis, hilar lymphadenopathy, and fear of splenic disruption and tumor spillage. In our experience, the adoption of a lateral technique and the use of hand-assisted devices has allowed for the successful completion of laparoscopic splenectomy for malignant hematologic diseases including spleens up to 28 cm in length and greater than 3 kg morcellated weight. Laparoscopic splenectomy reliably alleviates the symptoms related to splenomegaly and reverses the hematologic abnormalities of hypersplenism. Although laparoscopic splenectomy for malignant diseases is feasible, the role of minimally invasive surgery in the staging of Hodgkin's lymphoma remains undetermined.     

Laparoscopic splenectomy in the management of benign and malignant hematologic diseases.

OBJECTIVES: The use of laparoscopy to treat malignant hematological diseases is not completely accepted. Our aim was to analyze operative and postoperative results of laparoscopic splenectomy performed for benign versus malignant hematological disorders. METHODS: Between 1994 and 2003, 76 consecutive patients underwent laparoscopic splenectomy. The first 38 cases were performed by using an anterior approach, whereas in the remaining 38 cases a semilateral position was used. RESULTS: Baseline characteristics showed that patients with malignant diseases were significantly older (56.9 vs 32.6 years, P < 0.001). Seventy-two (94.7%) procedures were completed laparoscopically. Conversion was required in 4 cases (5.2%). Mean operative time was 138.5 minutes for benign and 151.0 minutes for malignant diseases, (P > 0.05, ns). The hand-assisted technique was used in 3 patients with massive splenomegaly. Pathologic features showed that spleen volume was higher in patients with malignant diseases (mean interpole diameter 18.1 cm vs 13.7 cm, P < 0.001). Massive splenomegaly (interpole diameter over 20 cm, weight over 1000 g) was present in 13 patients (17.1%); 9 had malignant diseases. Overall perioperative mortality was 1.3% and major postoperative complications occurred in 6 patients (7.8%). Postoperative splenoportal partial thrombosis was identified in 9.7% of patients. CONCLUSIONS: Laparoscopic splenectomy is a well-accepted, less-invasive procedure for hematological disorders. Neoplastic diseases or splenomegaly, or both, do not seem to limit the indications for a minimally invasive approach after the learning curve.     

Laparoscopic pancreaticoduodenectomy for benign and malignant diseases

Background Laparoscopy still is not universally accepted as an alternative approach for pancreatoduodenectomy. This study aimed to assess the feasibility and safety of laparoscopic pancreatoduodenectomy for benign and malignant lesions of the pancreas, and to examine whether this procedure obtains adequate margins and follows oncologic principles. To the best of the authors’ knowledge, their series of laparoscopic pancreatoduodenectomies is the largest reported to date. Methods A prospective study of laparoscopic pancreatoduodenectomy was undertaken between March 1999 and June 2005. The study enrolled 25 patients (16 women and 9 men) with a mean age of 62 ± 14 years. All the operations were performed in a single institution. Results The operations were performed without serious complications. Three patients underwent conversion to open surgery. For 13 patients, the anastomosis was performed intracorporeally. For the remaining 9 patients, the resection was performed laparoscopically, with the reconstruction performed through a small midline incision. There was no intraoperative mortality. The mean operating time was 287 ± 39 min, and the mean blood loss was 107 ± 48 ml. The mean time to the first bowel movement was 6 ± 1.5 days, and the mean time to independent self-care was 4.8 ± 0.8 days. Seven patients experienced postoperative complications. One patient died of a cardiac event 3 days after uncomplicated surgery. The mean hospital stay was 16.2 ± 2.7 days. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 18 ± 5. Conclusion: Laparoscopic pancreatoduodenectomy for selected cases of benign and malignant lesions performed by highly skilled laparoscopic surgeons is feasible and safe. This method can obtain adequate margins and follow oncological principles. Larger series and longer follow-up periods are needed to establish the current results.     

Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases

Background

Laparoscopic splenectomy has become the standard of care for benign hematological disease affecting the spleen; its role in massive splenomegaly remains controversial. In this study, we evaluated the outcome of laparoscopic splenectomies in terms of spleen size in a group of 83 patients of benign hematological diseases.

Methods

From July 2003 to December 2009, 83 patients underwent laparoscopic splenectomy for various benign hematological diseases. The data were recorded and analyzed in a retrospective manner. The patients were divided in to two groups according to the spleen weight; group I?<?2,000?g (n?=?54) and group II?>?2,000?g (n?=?29). Age, sex, hematological condition, operative time, estimated blood loss, conversion to open surgery, splenic weight, length of hospital stay, time to liquid diet, and morbidity were all recorded.

Results

Laparoscopic splenectomy was completed in 79 patients (95.2?%). Operative time (p?=?0.01) and estimated blood loss (p?=?0.001) was more in group II. The length of hospital stay (p?=?0.05) and the postoperative morbidity (p?=?0.001) also were significantly more in the second group. There was no mortality.

Conclusions

Laparoscopic splenectomy is possible and safe for massive splenomegaly in hematological disease (>2,000?g), but it needs longer operative time and hospital stay.     

Laparoscopic splenectomy for haematological diseases: review of current concepts and opinions.

Laparoscopic splenectomy is now currently used by most surgeons in the treatment of many haematological diseases. The operative technique varies depending on the surgeon, but results are usually comparable among published series. We have reviewed 104 papers about laparoscopic splenectomy for haematological diseases and paid particular attention to surgical aspects and early postoperative results. We searched MEDLINE from January 1989 to April 1998, and of the 104 papers that we found 41 fulfilled our criteria of large series published in peer-reviewed journals that had been cited often. They usually compared laparoscopic and open splenectomy and focused on common problems (such as accessory spleens) and technical aspects (such as bleeding). Laparoscopic splenectomy is reported by most authors to be as safe and effective as open splenectomy for haematological diseases. It also has several advantages over the open approach, such as shorter and less complicated postoperative stay with better cosmetic results and more rapid return to full activities.     

腹腔镜肝脏手术治疗肝脏占位性病变

目的 :探讨腹腔镜肝脏手术的可行性、适应证及方法。方法 :分析 1998年 6月至 2 0 0 2年 8月腹腔镜下肝脏手术 2 3例的临床资料。结果 :2 3例手术均在腹腔镜下完成 ,其中肝左外叶切除术 2例 ,肝癌局部切除术 7例 ,肝局限性结节状增生局部切除术 3例 ,肝血管瘤摘除术 1例 ,肝癌射频治疗 2例 ,肝囊肿开窗引流术 +胆囊切除术 7例 ,肝脓肿引流术 1例。平均手术时间 16 5min ,平均出血 12 0ml,术后 4 8h内胃肠功能恢复 ,术后平均住院 7.6d ,痊愈出院 ,无严重并发症发生。结论 :腹腔镜下肝脏手术 ,包括肝切除术是一种安全、有效、微创的手术 ,但应严格掌握适应证     

Laparoscopic splenectomy in the treatment of hematologic diseases

Laparoscopic approach to surgical procedures in children is used in different diseases, but there are some controversies for using this technique in the splenectomy. Laparoscopic surgery decreased pain, postoperative ileus and the hospital stay; and improve cosmetics, the most important disadvantage is the longer operating time. Splenectomy is indicated more in immune thrombocytopenic purpura (PTI) and hereditary espherocytosis (HE). We review our experience in laparoscopic spelenectomy.     

腹腔镜脾切除术治疗良性血液系统疾病13例报告

1991年Delaitre等完成了首例腹腔镜脾切除术（laparoscopic splenectomy，LS），此后该项技术逐渐成熟并得到国内外学者的广泛认同。我院2002年10月～2005年9月对13例有脾切除指征的良性血液系统疾病病人成功施行LS．术后取得良好疗效，现将结果报道如下。     

Laparoscopic splenectomy for non-traumatic diseases

At present, laparoscopic splenectomy (LS) is mostly indicated in hematologic benign diseases, and in case of normal size spleen it is considered the gold standard. The technique is under a continuous evolution and several studies have demonstrated feasibility and safety of laparoscopic approach also in case of massive splenomegaly, malignant diseases and even in the treatment of selected cases traumatic lesions. LS is an advanced surgical procedure that requires a management of a full trained team involved in the preoperative preparation, surgical strategy and postoperative care. A fully comprehension of the impact of the surgical strategy is needed to plan the treatment of diseases that often are managed in a multidisciplinary setting. Indications and contraindications to surgery does not differ significantly from open traditional splenectomy, but the nature of the disease and the volume of the spleen can greatly influence the operation. A preoperative study with definition of these parameters along with a standard preparation to surgery is required. Over the years the technique has been developed and adapted to respond to emergent necessities related to those parameters. Anterior, semilateral, later and hand assisted approaches offer advantages and drawbacks that should be weighed in each case. They depend on surgeons preferences but most of the time are related to the preoperative studies, even when new surgical tools (i.e. harmonic scalpel and radiofrequency). No randomized, prospective trials have been conducted, however several studies with strong evidence have shown that less surgical trauma, intraoperative blood loss, early hospital discharge, rapid return to normal activities and better cosmesis can be obtained with a laparoscopic approach.     

Laparoscopic splenectomy for hematological diseases

Background: We reviewed retrospectively the records of all patients who underwent laparoscopic splenectomy (LS) at our institution for a wide range of hematological disorders. We compared our experience to those reported in the literature and analyzed various aspects of the treatment that are still under discussion and in need of confirmation, such as the treatment of malignant blood diseases, the indication in case of splenomegaly, and the adequacy of the detection of accessory spleens. Methods: Between June 1997 and June 2001, we performed 43 LS. The patients were classified into three groups according to clinical diagnosis: idiopathic thrombocytopenic purpura (ITP) (n = 23), hemolytic anemia (HA) (n = 5), and hematological malignancy (HM) (n = 15). Statistical analyses were done to compare the three groups. Results: LS was completed in 41 patients, with a conversion rate of 5%. Splenomegaly was present in 37% of all patients (73% of HM). Mean operative time was 128 min. The incidence of accessory spleens was 20%. A concomitant laparoscopic procedure was done in three cases (cholecystectomy). Postoperative complications occurred in eight patients (18%). Duration of surgery, length of hospital stay, transfusions rate, and some demographics features, such as age and spleen weight and length, were significantly different in each group. No deaths were attributed to the procedure. Conclusions: The statistical analysis of our series shows that, the laparoscopic approach reliable even in the management of malignant and nonmalignant blood diseases.     

腹腔镜脾脏部分切除术治疗脾良性肿瘤的体会

目的 探讨腹腔镜脾脏部分切除术治疗脾脏良性肿瘤的效果。方法 对2014 年3 月至2019 年3月在宁波鄞州区第二医院普外科14 例行腹腔镜脾脏部分切除术的脾脏良性肿瘤患者临床资料进行回顾性分析。结果 14例均顺利完成手术,无中转开腹;手术时间（2.5±0.4）h,术中出血量（180±40）mL。术中无胰腺损失、大出血等并发症,住院时间（5.3±1.6）d,硅胶引流管放置时间（3.2±1.5）d,术后无腹腔感染、胰漏、出血等并发症发生,术后未见门静脉血栓形成。结论 腹腔镜脾脏部分切除术安全可行,值得推广。     

Transhiatal esophagectomy for treatment of benign and malignant esophageal diseases

In 1978 the technique of transhiatal esophagectomy without thoracotomy was rediscovered and now it is widely used in certain, selected, cases. Between 1987 and 2003 we have performed transhiatal esophagectomy in 35 patients with intrathoracic esophageal disease: 13 (37.14%) for benign lesions of the esophagus and 22 (62.85%) for malignant lesions (22.72% upper, 9% middle and 68.18% lower third of the thoracic esophagus). The reconstruction was performed at the same operation in all but two patients. The esophageal substitute was stomach in all but one patient when left colon was used. Hospital mortality was 14.28% with one death due to uncontrollable intraoperative hemorrhage. Major complications included anastomotic leak, recurrent laryngeal nerve paralysis, atelectasis/pneumonia. The advantages of this approach over standard transthoracic esophagectomy are avoidance of a combined thoracoabdominal operation in a debilitated patient and fewer postoperative pulmonary complications and also avoidance of an intrathoracic esophagogastric anastomotic leak with high mortality due to mediastinitis.     

Laparoscopic ureterolysis for benign and malignant conditions

Ureteral obstruction secondary to extrinsic compression is uncommon. Extrinsic compression results from both benign and malignant conditions of the retroperitoneum. In certain patients, laparoscopic ureterolysis is a minimally invasive alternative to the open approach. To date, the largest numbers of patients have undergone this procedure for idiopathic retroperitoneal fibrosis. Select patients with ureteral obstruction following cancer chemotherapy or radiotherapy may also be candidates for laparoscopic ureterolysis, although experience is limited. This article reviews the current indications, technique, and results of laparoscopic ureterolysis for both benign and malignant conditions. Further long-term studies are required to define its role.     

Laparoscopic splenectomy for treatment of splenomegaly

BACKGROUND: Laparoscopic splenectomy presents an advantage over open splenectomy, resulting in shorter hospital stay, decreased blood loss, and fewer operative and postoperative complications. Splenomegaly has long been considered a contraindication for laparoscopic splenectomy; however, in the hands of an experienced surgeon, this technique can be effectively applied to the treatment of splenomegaly. METHODS: Records for patients undergoing laparoscopic splenectomy for splenomegaly between 2000 and 2003, performed by a single surgeon in three community-based hospitals, were reviewed and demographic, operative, and postoperative data compiled. Preoperative diagnoses included B cell lymphoma, hemolytic anemia, and chronic lymphocytic leukemia. RESULTS: Seven patients underwent laparoscopic and hand-assisted laparoscopic splenectomy for splenomegaly during this time period. Splenic weights ranged from 410 to 3,100 g, and average operative time was 86.6 minutes. Estimated blood loss ranged from 50 to 350 ml; average hospital stay was 4.4 days. Two postoperative complications, ie, postoperative bleeding and superficial wound breakdown, were noted. CONCLUSIONS: Laparoscopic and hand-assisted laparoscopic splenectomy are effective methods for treatment of splenomegaly.     

Laparoscopic surgery for benign colorectal diseases

Since 1991 when the first cases of laparoscopic colectomy were reported, this technique has become widespread in colorectal surgery. Its reliability in colorectal cancer has been demonstrated but indications must still be limited to strictly controlled clinical trials that will determine its impact in terms of cancerology outcome. Inversely, for benign colorectal disease, the efficacy, low morbidity and the generally observed clinical benefit of laparoscopy compared with laparotomy, particularly in terms of patient comfort in the post-operative period and delay to normal activities, has been clearly demonstrated in several, though too often uncontrolled, trials. Laparoscopy will thus become more and more widespread and probably predominant for benign colorectal disease. Today, it is warranted to propose first-intention laparoscopic procedures for elective diverticulitis sigmoidectomy, for ileocecal resection for Crohn's disease, for derivation stomies, and finally, for surgical ablation of voluminous colonic polyps. In hands well trained in laparoscopic and colorectal surgery, laparoscopic procedures will be proposed in the near future for total colectomy, rectopexia, or even ileo-anal anastomosis.     

Laparoscopic splenectomy in the management of hematological diseases

After being successfully applied to other intraabdominal organs, the laparoscopic approach has been applied to the spleen since 1991. The experience with 17 cases of laparoscopic splenectomy performed due to immune thrombocytopenia purpura (10 instances), hereditary spherocytosis (2 cases), and Hodgkin's disease where the staging was done according to Stanford (5 cases), have been reported. With the patient in anti-Trendelenburg position, and the surgeon between the patient's legs, four or five trocars are introduced into the upper abdominal quadrants and the spleen hilum is isolated. Hilar vessels are dissected and ligated with a surgical stapler. A plastic bag is introduced into the abdomen cavity and the spleen is slipped inside; it is then extracted through an umbilical incision after morcellation. Advantages of the open operation include a decrease in postoperative pain, a decrease in pulmonary sequelae, a reduced incidence of subphrenic abscesses, and cosmetic advantages. The decrease of postoperative sequelae reduces hospitalization and costs, which are higher for the operation itself (materials and staff's training).