Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS)

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

The Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) was developed to provide at the national level an informative tool useful for performing multicenter studies in the field of spleen laparoscopic surgery. In this first study analyzing the IRLSS data, a cohort of patients with hematologic diseases was retrospectively investigated for potential predictive parameters that could affect the outcome of laparoscopic splenectomy.

Methods

A total of 309 patients who underwent laparoscopic splenectomy for hematologic diseases in 17 Italian centers (between February 1, 1993, and September 30, 2004) were entered in the IRLSS. Their records were analyzed retrospectively by the Student’s t-test, chi-square, and logistic regression.

Results

The mean operative time was 141 min (range, 30–420 min). Conversion was necessary in 21 cases (7%), and approximately 1 accessory spleen in 25 patients (9%) was found. The mean spleen weight was 1191 g (range, 85–4,500 g). Perioperative death occurred in two cases (0.6%). No complications were experienced by 253 patients (81.9%), who had a mean hospital stay of 5.4 days (range, 2–30 days). Overall morbidity occurred in 56 patients (18.1%), mainly associated with transient fever (n = 22), pleural effusion (n = 13), and actual or suspected hemorrhage (n = 12), requiring a reintervention for 7 patients. Multivariate analysis found that body mass index (p = 0.024) and clinical indication (p = 0.004) were independent predictors for surgical conversion. The clinical indication was almost significant as an independent predictor for the occurrence of postoperative complication (p = 0.05).

Conclusions

This first study analyzing the IRLSS data shows that laparoscopic splenectomy may represent the gold standard treatment for hematologic diseases with normal-size spleen. The low morbidity and mortality rate suggests that laparoscopic splenectomy can be successfully proposed also for splenomegaly in hematologic malignancies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Decker G, Millat B, Guillon F, Atger J, Linon M (1998) Laparoscopic splenectomy for benign and malignant hematologic diseases: 35 consecutive cases. World J Surg 22: 62–68

    Article  PubMed  CAS  Google Scholar 

  2. Delaître B (1995) Laparoscopic splenectomy: the “hanged spleen” technique. Surg Endosc 9: 528–529

    PubMed  Google Scholar 

  3. Delaître B, Maignien B (1991) Splenectomy by the laparoscopic approach: report of a case. Presse Med 20: 2263

    PubMed  Google Scholar 

  4. Donini A, Baccarani U, Terrosu G, Corno V, Ermacora A, Pasqualucci A, Bresadola F (1999) Laparoscopic vs open splenectomy in the management of hematologic disease. Surg Endosc 13: 1220–1225

    Article  PubMed  CAS  Google Scholar 

  5. Flowers JL, Lefor AT, Steers J, Heyman M, Graham SM, Imbembo AL (1996) Laparoscopic splenectomy in patients with hematologic diseases. Ann Surg 224: 19–28

    Article  PubMed  CAS  Google Scholar 

  6. Friedman RL, Fallas MJ, Carroll BJ, Hiatt JR, Phillips EH (1996) Laparoscopic splenectomy for ITP: the gold standard. Surg Endosc 10: 991–995

    Article  PubMed  CAS  Google Scholar 

  7. Goldstone J (1978) Splenectomy for massive splenomegaly. Am J Surg 135: 385–388

    Article  PubMed  CAS  Google Scholar 

  8. Gossot D, Fritsch S, Célérier M (1999) Laparoscopic splenectomy: optimal vascular control using the lateral approach and ultrasonic dissection. Surg Endosc 13: 21–25

    Article  PubMed  CAS  Google Scholar 

  9. Grossbard ML (1996) Is laparoscopic splenectomy appropriate for the management of hematologic and oncologic disease? Surg Endosc 10: 387–388

    Article  PubMed  CAS  Google Scholar 

  10. Horowitz J, Smith JL, Weber TK, Rodriguez-Bigas MA, Petrelli NJ (1996) Postoperative complications after splenectomy for hematologic malignancies. Ann Surg 223: 290–296

    Article  PubMed  CAS  Google Scholar 

  11. Johnson HA, Deterling RA (1989) Massive splenomegaly. Surg Gynecol Obstet 168: 131–137

    PubMed  CAS  Google Scholar 

  12. Katkhouda N, Hurwitz MB, Rivera RT, Chandra M, Waldrep DJ, Gugenheim J, Mouiel J (1998) Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg 228: 568–578

    Article  PubMed  CAS  Google Scholar 

  13. Keidar A, Feldman M, Szold A (2005) Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count. Am J Hematol 80: 95–100

    Article  PubMed  CAS  Google Scholar 

  14. Kercher KW, Matthews BD, Walsh RM, Sing RF, Backus CL, Heniford BT (2002) Laparoscopic splenectomy for massive splenomegaly. Am J Surg 183: 192–196

    Article  PubMed  Google Scholar 

  15. Knauer EM, Ailawadi G, Yahanda A, Obermeyer RJ, Millie MP, Ojeda H, Mulholland MW, Colletti L, Sweeney JF (2003) 101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders. Am J Surg 186: 500–504

    Article  PubMed  Google Scholar 

  16. Letoquart JP, La Gamma A, Kunin N, Grosbois B, Mambrini A, Leblay R (1993) Splenectomy for splenomegaly exceeding 1000 grams: analysis of 47 patients. Br J Surg 80: 334–335

    PubMed  CAS  Google Scholar 

  17. Liew SC, Storey DW (1995) Laparoscopic splenectomy. Aust N Z J Surg 65: 743–745

    PubMed  CAS  Google Scholar 

  18. Mahon D, Rhodes M (2003) Laparoscopic splenectomy: size matters. Ann R Coll Surg Engl 85: 248–251

    Article  PubMed  Google Scholar 

  19. Morgenster L, Skandalakis JE (1997) Anatomy and embryology of the spleen. In: Hiatt JR, Phillips EH, Mongenstern L (eds) Surgical diseases of the spleen. Springer, Berlin, pp 15–24

    Google Scholar 

  20. Park A, Birgisson G, Mastrangelo MJ, Maraccio MJ, Witzke DB (2000) Laparoscopic splenectomy: outcomes and lessons learned from over 200 cases. Surgery 128: 660–667

    Article  PubMed  CAS  Google Scholar 

  21. Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, O’Rourke N, Nathanson L, Fielding G (2003) Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 238: 235–240

    Article  PubMed  Google Scholar 

  22. Poulin EC, Thibault C, Mamazza J (1995) Laparoscopic splenectomy. Surg Endosc 9: 172–177

    Article  PubMed  CAS  Google Scholar 

  23. Rady MY, Johnson DJ (2004) Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians. Chest 126: 1583–1591

    Article  PubMed  Google Scholar 

  24. Ratner LE, Smith P, Montgomery RA, Mandal AK, Fabrizio M, Kavoussi LR (2000) Laparoscopic live donor nephrectomy: preoperative assessment of technical difficulty. Clin Transplant 14: 427–432

    Article  PubMed  CAS  Google Scholar 

  25. Rege RV, Merriam LT, Joehl RJ (1996) Laparoscopic splenectomy. Surg Clin North Am 76: 459–468

    Article  PubMed  CAS  Google Scholar 

  26. Rosen M, Brody F, Walsh RM, Ponsky J (2002) Hand-assisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly. Arch Surg 137: 1348–1352

    Article  PubMed  Google Scholar 

  27. Samama G, Le Roux Y, Brefort JL, Reman O, Leporrier M (1995) Place of celio-video-surgery in splenectomy for hematologic diseases. Ann Chir 49: 482–486

    PubMed  CAS  Google Scholar 

  28. Schlachta CM, Poulin EC, Mamazza L (1999) Laparoscopic splenectomy for hematologic malignancies. Surg Endosc 13: 865–868

    Article  PubMed  CAS  Google Scholar 

  29. Shaw JHF, Clark M (1989) Splenectomy for massive splenomegaly. Br J Surg 76: 395–397

    PubMed  CAS  Google Scholar 

  30. Szold A, Sagi B, Merhav H, Klausner JM (1998) Optimizing laparoscopic splenectomy: technical details and experience in 59 patients. Surg Endosc 12: 1078–1081

    Article  PubMed  CAS  Google Scholar 

  31. Targarona EM, Balague C, Trias M (2004) Is the laparoscopic approach reasonable in cases of splenomegaly? Semin Laparosc Surg 11: 185–190

    PubMed  Google Scholar 

  32. Targarona EM, Espert JJ, Balaguè C, Piulachs J, Artigas V, Trias M (1998) Splenomegaly should not be considered a contraindication for laparoscopic splenectomy. Ann Surg 228: 35–39

    Article  PubMed  CAS  Google Scholar 

  33. Targarona EM, Espert JJ, Bombuy E, Vidal O, Cerdan G, Artigas V, Trias M (2000) Complications of laparoscopic splenectomy. Arch Surg 135: 1137–1140

    Article  PubMed  CAS  Google Scholar 

  34. Terrosu G, Baccarani U, Bresadola V, Sistu MA, Uzzau A, Bresadola F (2002) The impact of splenic weight on laparoscopic splenectomy for splenomegaly. Surg Endosc 16: 103–107

    Article  PubMed  CAS  Google Scholar 

  35. Terrosu G, Donini A, Baccarani U, Vianello V, Anania G, Zala F, Pasqualucci A, Bresadola F (1998) Laparoscopic versus open splenectomy in the management of splenomegaly: our preliminary experience. Surgery 124: 839–843

    PubMed  CAS  Google Scholar 

  36. Torelli P, Cavaliere D, Casaccia M, Panaro F, Grondona P, Rossi E, Santini G, Truini M, Gobbi M, Bacigalupo A, Valente U (2002) Laparoscopic splenectomy for hematological diseases. Surg Endosc 16: 965–971

    Article  PubMed  CAS  Google Scholar 

  37. Torelli P, Grondona P, Casaccia M, Cavaliere D, Panaro F, Valente U (2002) Italian registry for laparoscopic splenectomy: first presentation. Surg Endosc 16: S64

    Article  Google Scholar 

  38. Walsh RM, Brody F, Brown N (2004) Laparoscopic splenectomy for lymphoproliferative disease. Surg Endosc 18: 272–275

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was technically supported by the Italian Society for Endoscopic Surgery and New Technologies (SICE; http://www.siceitalia.com).

Author information

Authors and Affiliations

  1. Advanced Laparoscopic Unit, Department of General Surgery and Transplant, San Martino University Hospital, University of Genoa, Monoblocco IV Piano, Largo R. Benzi 10, 16132, Genoa, Italy

    M. Casaccia, P. Torelli, A. Savelli, B. Troilo, G. Santori & U. Valente (for IRLSS Centers)

  2. Physic and Medical Statistics Laboratory, Department of Physic, University of Genoa, Genoa, Italy

    S. Squarcia

  3. Clinical Epidemiology Unit, National Institute for Cancer Research, Genoa, Italy

    M. P. Sormani

Authors
  1. M. Casaccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Torelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Squarcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. P. Sormani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Savelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Troilo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Santori
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. U. Valente
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Casaccia.

Additional information

IRLSS Centers: SS Antonio e Biagio Hospital, Alessandria (Dr. G. Spinoglio); F. Miulli Regional Hospital, Acquaviva delle Fonti (Dr. G. Logrieco); Bufalini Hospital, Cesena (Dr. F. Buccoliero); Careggi Hospital, Florence (Dr. A. Valeri); Cisanello Hospital, Pisa (Dr. A. Pietrabissa); Arcispedale S. Maria Nuova, Reggio Emilia (Dr. C. Pedrazzoli); San Gerardo Hospital, Monza (Dr. F. Uggeri); University Hospital, Modena (Prof. M. Saviano); Policlinic University Hospital, Udine (Prof. F. Bresadola); Humanitas Clinical Institute, Rozzano (Dr. R. Rosati); S. Anna Hospital, Ferrara (Dr. I. Donini); San Giacomo Hospital, Rome (Dr. A. Moraldi); San Martino University Hospital, Genoa (Dr. P. Torelli); San Paolo Hospital, Savona (Prof. P. Cavaliere); Santo Spirito Hospital, Pescara (Dr. G. Colecchia); Umberto I Hospital, Rome (Prof. N. Basso); Policlinic University Hospital, Bari (Prof. F. Prete)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Casaccia, M., Torelli, P., Squarcia, S. et al. Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS). Surg Endosc 20, 1214–1220 (2006). https://doi.org/10.1007/s00464-005-0527-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0527-5

Keywords

Search

Navigation