Are there any limits for laparoscopy in splenomegaly? Our experience
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ORIGINAL ARTICLE
Are there any limits for laparoscopy in splenomegaly? Our experience Mauro Santarelli1 · Giacomo Lo Secco2 · Daniele Celi3 · Gitana Scozzari4 · Patrick Pautasso5 · Paolo De Paolis1 Received: 10 March 2020 / Accepted: 30 August 2020 © Italian Society of Surgery (SIC) 2020
Abstract Laparoscopic splenectomy in the case of massive or supermassive splenomegaly has been associated with higher conversion rates and morbidity. The purpose of our study is to evaluate the feasibility and safety of laparoscopic splenectomy for massive spleens and to identify if there are limits beyond which the laparoscopic approach is not recommended in massive and supermassive spleens. This is a retrospective study of 93 consecutive laparoscopic splenectomies in adult patients performed by a single surgeon, from January 2008 to December 2017. The data collected included the patient’s age, sex, ASA, spleen weight, volume and dimension, type of disease, hospital stay, surgical technique, operative time. Median splenic weight was 400 g (range 65–3800 g) and median volume was 1365 cc (range 600–3800). Median operative time was 120 min and the overall conversion rate was 5.4%. Globally, 52 patients (55.9%) had a normal-weight spleen, 25 (26.9%) had massive and 16 (17.2%) had supermassive splenomegaly. In splenomegaly group (n = 41), patient’s age, percentage of malignant diagnosis, spleen weight, anteroposterior (AP), medio-lateral (ML) and craniocaudal (CC) diameter, surgical time and conversion rate were significantly higher compared to normal-weight spleen patients. None of the normal-weight spleen patients underwent open conversion, while 5 patients among 41 splenomegalic cases underwent laparotomic conversion (12.2%). Comparing massive and super-massive patients, the latter showed longer operative time and hospital length of stay, and higher conversion rate. We identified as significant cut-off limits for higher conversion risk a spleen weight ≥ 1300 g and a spleen CC diameter ≥ 22 cm. In our experience laparoscopy was the gold standard in the case of spleen weight and diameter equal to or less than 1300 g and 22 cm, but it was safe and feasible also in the case of larger spleens, taking into account the greater risk of conversion. Keywords Laparoscopic splenectomy · Splenomegaly · Supermassive splenomegaly · Splenectomy
Introduction
* Mauro Santarelli [email protected] 1
Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino “Molinette”, SC Chirurgia Generale e d’Urgenza 3, Corso Bramante 88, 10126 Turin, Italy
2
Department of Surgical Sciences, University of Torino, Turin, Italy
3
Department of Surgical Sciences, Azienda Ospedaliera San Lazzaro, Alba, Italy
4
Hospital Medical Direction, AOU Città della Salute e della Scienza di Torino “Molinette”, Turin, Italy
5
Department of Radiology, AOU Città della Salute e della Scienza di Torino “CTO”, Turin, Italy
Since the first description by Delaitre and Maignien in 1991 [1] laparoscopic splenectomy (LS) has evolved as a s
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