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Guidelines for the performance of minimally invasive splenectomy

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Abstract

Background

Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical and peri-operative approaches to MIS is unclear.

Objective

To develop evidence-based guidelines that support clinicians, patients, and others in decisions on the peri-operative performance of MIS.

Methods

A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) including methodologists used the Grading of Recommendations Assessment, Development and Evaluation approach to grade the certainty of evidence and formulate recommendations.

Results

Informed by a systematic review of the evidence, the panel agreed on eight recommendations for the peri-operative performance of MIS for adults and children in elective situations addressing six key questions.

Conclusions

Conditional recommendations were made in favor of lateral positioning for non-hematologic disease, intra-operative platelet administration for patients with idiopathic thrombocytopenic purpura instead of preoperative administration, and the use of mechanical devices to control the splenic hilum. Further, a conditional recommendation was made against routine intra-operative drain placement.

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Acknowledgements

The authors thank Sarah Colon (SAGES) for administrative support and Shauna Bostian and Holly Burt for librarian support.

Author information

Authors and Affiliations

  1. Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA

    Tammy L. Kindel

  2. Department of Surgery, Indiana University School of Medicine, Indianapolis, USA

    Rebecca C. Dirks, Amelia T. Collings & Dimitrios Stefanidis

  3. Department of Surgery, Division of Pediatric Surgery, University of Pittsburgh, Pittsburgh, USA

    Stefan Scholz

  4. Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

    Ahmed M. Abou-Setta

  5. Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, USA

    Vamsi V. Alli

  6. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada

    Mohammed T. Ansari

  7. Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, USA

    Ziad Awad

  8. Department of Surgery, Vanderbilt University Medical Center, Nashville, USA

    Joseph Broucek

  9. Department of Surgery, University of California, San Francisco, San Francisco, USA

    Andre Campbell

  10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA

    Michael W. Cripps

  11. Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA

    Celeste Hollands

  12. Department of Surgery, University of Oklahoma School of Medicine Tulsa, Tulsa, USA

    Robert Lim

  13. Chicago Institute of Advanced Surgery, Chicago, USA

    Francisco Quinteros

  14. Division of Pediatric Hematology and Oncology, University of Pittsburgh, Pittsburgh, USA

    Kim Ritchey

  15. Indiana University School of Medicine, Indianapolis, USA

    Jake Whiteside

  16. Charles George Veterans Affairs Medical Center, Asheville, USA

    Bradley Zagol

  17. Department of Surgery, Stony Brook University, Stony Brook, USA

    Aurora D. Pryor

  18. Department of Surgery, East Carolina University, Greenville, USA

    Danielle Walsh

  19. NorthShore University Health System, Evanston, USA

    Stephen Haggerty

Authors
  1. Tammy L. Kindel
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  2. Rebecca C. Dirks
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  3. Amelia T. Collings
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  4. Stefan Scholz
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  5. Ahmed M. Abou-Setta
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  6. Vamsi V. Alli
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  7. Mohammed T. Ansari
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  8. Ziad Awad
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  9. Joseph Broucek
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  10. Andre Campbell
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  11. Michael W. Cripps
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  12. Celeste Hollands
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  13. Robert Lim
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  14. Francisco Quinteros
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  15. Kim Ritchey
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  16. Jake Whiteside
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  17. Bradley Zagol
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  18. Aurora D. Pryor
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  19. Danielle Walsh
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  20. Stephen Haggerty
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  21. Dimitrios Stefanidis
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Contributions

TK was the panel Chair, wrote the first draft of the manuscript, and revised the manuscript based on author’s suggestions; RD and AC were the panel co-chairs and non-voting members, contributed to drafting and critical revisions of the manuscript and contributed to further drafts, moderated the panel sessions, and checked the manuscript accuracy; AMAS and MTA provided methodological support; DW, SH, and DS provided supervision and guidance throughout the development process and critically revised this guideline. Guideline panel members (see Supplementary Material Appendix A), participated in the creation of the EtD tables (Supplementary Material Appendix C), critically reviewed the manuscript and provided suggestions for improvement. All authors approved the content.

Corresponding author

Correspondence to Dimitrios Stefanidis.

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Disclosures

A full list of disclosures and conflicts of interest can be found in Supplementary Material Appendix B. All conflicts of interest and disclosures were assessed as not having influenced the construction of the Guidelines.

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Kindel, T.L., Dirks, R.C., Collings, A.T. et al. Guidelines for the performance of minimally invasive splenectomy. Surg Endosc 35, 5877–5888 (2021). https://doi.org/10.1007/s00464-021-08741-2

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  • DOI: https://doi.org/10.1007/s00464-021-08741-2

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