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World Journal of Surgery

, Volume 43, Issue 6, pp 1505–1518 | Cite as

Feasibility and Safety of Laparoscopic Partial Splenectomy: A Systematic Review

  • Gangshan Liu
  • Ying FanEmail author
Scientific Review

Abstract

Background

Laparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits.

Methods

We conducted a comprehensive review for the years 1995–2018 to retrieve all relevant articles.

Results

A total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50–225 min and 0–1200 ml, respectively. There are eight patients need blood transfusion in 231 patients with available data. The conversion rate was 3.6% (9/252). Overall, 27 patients (10.7%;27/252) developed postoperative or intraoperative complications. Overall mortality was 0% (0/252). The length of postoperative stay (POS) varied (1–11 days). Among four comparative studies, one showed LPS could reduce POS than laparoscopic total splenectomy (LTS) (LTS 5.4 ± 1.8 days, LPS 4.2 ± 0.8 days, p = 0.027) and complications (pleural effusion (LTS 9/22, LPS 0/15, p = 0.005), splenic vein thrombosis (LTS 10/22, LPS 0/15, p = 0.002)). Another comparative study showed LPS may benefit emergency patients. However, one comparative study showed LPS was associated with more pain, longer time to oral intake, and longer POS in children with hereditary spherocytosis. The fourth comparative study showed robotic subtotal splenectomy was comparable to laparoscopy in terms of POS and complication. The main benefits were lower blood loss, vascular dissection time, and a better evaluation of splenic remnant volume.

Conclusions

In early series of highly selected patients, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons.

Notes

Acknowledgement

Gangshan Liu contributed to literature research and manuscript preparation. Ying Fan contributed to literature research and approved the final version of manuscript.

Compliance with ethical standards

Conflicts of interest

Dr. Liu and Dr. Fan have no conflicts of interest or financial ties to disclose. Informed consent was obtained from all individual participants included in this review.

References

  1. 1.
    Singer DB (1973) Postsplenectomysepsis. In: Anonymous: Perspectives in pediatric pathology, 1edn Year Book Medical Publishers, Chicago, pp 285–311Google Scholar
  2. 2.
    Wolf HM, Eibl MM, Georgi E et al (1999) Long-term decrease of CD4?CD45RA?T cells and impaired primary immune response after post-traumatic splenectomy. Br J Haematol 107:55–68CrossRefGoogle Scholar
  3. 3.
    Hansen K, Singer DB (2001) Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol 4:105–121CrossRefGoogle Scholar
  4. 4.
    Tracy ET, Haas KM, Gentry T, Danko M, Roberts JL, Kurtzberg J, Rice HE (2011) Partial splenectomy but not total splenectomy preserves immunoglobulin M memory B cells in mice. J Pediatr Surg 46:1706–1710CrossRefGoogle Scholar
  5. 5.
    Uranues S, Grossman D, Ludwig L et al (2007) Laparoscopic partial splenectomy. Surg Endosc 21:57–60CrossRefGoogle Scholar
  6. 6.
    Hery G, Becmeur F, Mefat L et al (2008) Laparoscopic partial splenectomy: indications and results of a multicenter retrospective study. Surg Endosc 22:45–49CrossRefGoogle Scholar
  7. 7.
    Ikeda M, Sekimoto M, Takiguchi S et al (2007) Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment. Am J Surg 193:21–25CrossRefGoogle Scholar
  8. 8.
    De Schepper AM, Vanhoenacker F, de Beeck BO et al (2005) Vascular pathology of the spleen, part I. Abdom Imaging 30:96–104CrossRefGoogle Scholar
  9. 9.
    Madoff DC, Denys A, Wallace MJ et al (2005) Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics 25(Suppl 1):S191–S211CrossRefGoogle Scholar
  10. 10.
    Uranüs S, Pfeifer J, Schauer C et al (1995) Laparoscopic partial splenic resection. Surg Laparosc Endosc 5:133–136Google Scholar
  11. 11.
    Poulin EC, Thibault C, DesCôteaux JG et al (1995) Partial laparoscopic splenectomy for trauma: technique and case report. Surg Laparosc Endosc 5:306–310Google Scholar
  12. 12.
    Hong TH, Lee SK, You YK et al (2010) Single-port laparoscopic partial splenectomy: a case report. Surg Laparosc Endosc Percutan Tech 20:e164–e166CrossRefGoogle Scholar
  13. 13.
    Robert L, Soares JR et al (1998) Laparoscopic complete excision of a splenic epidermoid cyst. J Laparosc Adv Surg Tech 8:237–240CrossRefGoogle Scholar
  14. 14.
    Khelif K, Maassarani F, Dassonville M et al (2006) Laparoscopic partial splenectomy using radiofrequency ablation for nonparasitic splenic cysts in two children. J Laparosc Adv Surg Tech 16:414–417CrossRefGoogle Scholar
  15. 15.
    Gumbs AA, Bouhanna P, Bar-Zakai B et al (2008) Laparoscopic partial splenectomy using radiofrequency ablation. J Laparosc Adv Surg Tech 18:611–613CrossRefGoogle Scholar
  16. 16.
    Jain P, Parelkar S, Shah H et al (2008) Laparoscopic partial splenectomy for splenic epidermoid cyst. J Laparosc Adv Surg Tech 18:899–902CrossRefGoogle Scholar
  17. 17.
    Hua F, Zhang D, Xin Z et al (2011) Laparoscopic partial splenectomy for large splenic epidermoid cyst. Chin Med J 124:1751–1753Google Scholar
  18. 18.
    Lima M, Reinberg O, Ruggeri G et al (2013) 3D virtual rendering before laparoscopic partial splenectomy in children. J Pediatr Surg 48:1784–1788CrossRefGoogle Scholar
  19. 19.
    Garza-Serna U, Ovalle-Chao C, Martinez D et al (2017) Laparoscopic partial splenectomy for congenital splenic cyst in a pediatric patient: case report and review of literature. Int J Surg Case Rep 33:44–47CrossRefGoogle Scholar
  20. 20.
    Wang X, Wang M, Zhang H et al (2014) Laparoscopic partial splenectomy is safe and effective in patients with focal benign splenic lesion. Surg Endosc 28:3273–3278CrossRefGoogle Scholar
  21. 21.
    Dudi-Venkata NN, Houli N, Weinberg L et al (2014) Laparoscopic partial splenectomy performed by monopolar saline-cooled radiofrequency coagulation. J Laparosc Adv Surg Tech 24:502–505CrossRefGoogle Scholar
  22. 22.
    de la Villeon B, Zarzavadjian Le Bian A, Vuarnesson H et al (2015) Laparoscopic partial splenectomy: a technical tip. Surg Endosc 29:94–99CrossRefGoogle Scholar
  23. 23.
    Lee SH, Lee JS, Yoon YC et al (2015) Role of laparoscopic partial splenectomy for tumorous lesions of the spleen. J Gastrointest Surg 19:1052–1058CrossRefGoogle Scholar
  24. 24.
    Cai HH, An Y, Wu D et al (2016) Laparoscopic partial splenectomy: a preferred method for select patients. J Laparosc Adv Surg Tech 00:1–6Google Scholar
  25. 25.
    Corcione F, Cuccurullo D, Caiazzo P et al (2003) Laparoscopic partial splenectomy for a splenic pseudocyst. Surg Endosc 17:1850Google Scholar
  26. 26.
    Smith ST, Scoot DJ, Burdick JS et al (2001) Laparoscopic marsupialization and hemisplenectomy for splenic cysts. J Laparosc Adv Surg Tech 11:243–249CrossRefGoogle Scholar
  27. 27.
    Iimuro Y, Okada T, Sueoka H et al (2013) Laparoscopic management of giant splenic true cyst with partial splenectomy: a case report. Asian J Endosc Surg 6:226–230CrossRefGoogle Scholar
  28. 28.
    Vasilescu C, Tudor S, Popa M et al (2010) Robotic partial splenectomy for hydatid cyst of the spleen. Langenbecks Arch Surg 395:1169–1174CrossRefGoogle Scholar
  29. 29.
    Chinnusamy P, Ahluwalia JS, Palanisamy S et al (2013) Single incision multi-trocar hepatic cyst with partial splenectomy. J Minim Access Surg 9(2):91–94CrossRefGoogle Scholar
  30. 30.
    Quesada R, Poves M, Iglesias E Berjano et al (2016) Laparoscopic partial splenectomy for giant cyst using a radiofrequency-assisted device: a case report. Surg Case Rep 2:82CrossRefGoogle Scholar
  31. 31.
    Morinis J, Dutta S, Blanchette V et al (2008) Laparoscopic partial vs total splenectomy in children with hereditary spherocytosis. J Pediatr Surg 43:1649–1652CrossRefGoogle Scholar
  32. 32.
    Rescorla FJ, West KW, Engum SA et al (2007) Laparoscopic splenic procedures in children: experience in 231 children. Ann Surg 246:683–687CrossRefGoogle Scholar
  33. 33.
    Slater BJ, Chan FP, Davis K et al (2010) Institutional experience with laparoscopic partial splenectomy for hereditary spherocytosis. J Pediatr Surg 45:1682–1686CrossRefGoogle Scholar
  34. 34.
    Vasilescu C, Stanciulea O, Tudor S (2012) Laparoscopic versus robotic subtotal splenectomy in hereditary spherocytosis. Potential advantages and limits of an expensive approach. Surg Endosc 26:2802–2809CrossRefGoogle Scholar
  35. 35.
    Vasilescu C, Stanciulea O, Popa M et al (2008) Subtotal laparoscopic splenectomy and esophagogastric devascularization for the thrombocytopenia because of portal cavernoma—case report. J Pediatr Surg 43:1373–1375CrossRefGoogle Scholar
  36. 36.
    Okano K, Kakinoki K, Suto H et al (2011) Hand-assisted laparoscopic partial splenectomy using an endopath monopolar sealer. Surg Laparosc Endosc Percutan Tech 21:e291–e294CrossRefGoogle Scholar
  37. 37.
    Budzyński A, Demczuk S, Kumiega B et al (2011) Sclerosing angiomatoid nodular transformation of the spleen treated by laparoscopic partial splenectomy. Videosurg Other Miniinvasive Tech 6(4):249–255CrossRefGoogle Scholar
  38. 38.
    Breitenstein S, Scholz T, Schäfer M et al (2006) Laparoscopic partial splenectomy. J Am Coll Surg 204:179–181CrossRefGoogle Scholar
  39. 39.
    Patrzyk M, Glitsch A, Hoene A et al (2011) Laparoscopic partial splenectomy using a detachable clamp with and without partial splenic embolisation. Langenbecks Arch Surg 396:397–402CrossRefGoogle Scholar
  40. 40.
    Benetatos N, Filobbos R, Ammor B (2011) Laparoscopic partial splenectomy for littoral cell angioma. J Surg Case Rep 7:4CrossRefGoogle Scholar
  41. 41.
    Zhang Y, Chen XM, Sun DL et al (2014) Treatment of hemolymphangioma of the spleen by laparoscopic partial splenectomy: a case report. World J Surg Oncol 12:60.  https://doi.org/10.1186/1477-7819-12-60 CrossRefGoogle Scholar
  42. 42.
    Han XL, Zhao YP, Chen G et al (2015) Laparoscopic partial splenectomy for splenic hemangioma: experience of a single center in six cases. Chin Med J 128:694–697CrossRefGoogle Scholar
  43. 43.
    Wang WD, Lin J, Wu ZQ et al (2015) Partial splenectomy using a laparoscopic bipolar radiofrequency device: a case report. World J Gastroenterol 21(11):3420–3424CrossRefGoogle Scholar
  44. 44.
    Vega EA, Yamashita S, Shin CY et al (2017) Laparoscopic partial splenectomy for unknown primary cancer: a stepwise approach. Ann Surg Oncol 24:1134CrossRefGoogle Scholar
  45. 45.
    Li H, Wei Y, Peng B et al (2017) Feasibility and safety of emergency laparoscopic partial splenectomy. Medicine 96:16Google Scholar
  46. 46.
    De Greef E et al (2008) Partial laparoscopic splenectomy for splenic abscess because of Salmonella infection: a case report. J Pediatr Surg 43(5):E35–E38CrossRefGoogle Scholar
  47. 47.
    Petroianu A, Cabezas-Andrade MA, Neto RB (2008) Laparoscopic subtotal splenectomy. Surg Laparosc Endosc Percutan Tech 18:94–97CrossRefGoogle Scholar
  48. 48.
    Seshadri PA, Poulin EC, Mamazza J et al (2000) Technique for laparoscopic partial splenectomy. Surg Laparosc Endosc Percutan Tech 10:106–109CrossRefGoogle Scholar
  49. 49.
    De Pastena M, Nikamp MW et al (2018) Laparoscopic hemi-splenectomy. Surg Today 48:735–738CrossRefGoogle Scholar
  50. 50.
    Zheng L, Deng C, Li J et al (2018) Treatment of hemangioma of the spleen by preoperative partial splenic embolization plus laparoscopic partial splenectomy: a case report. Medicine 97:17Google Scholar
  51. 51.
    Ramia JM, de la Plaza Llamas R, López-Marcano AJ et al (2017) Laparoscopic partial splenectomy for a splenic epidermoid cyst. Cir Esp 95:613–615CrossRefGoogle Scholar
  52. 52.
    Chen J, Shian Y, Longtang X (2018) Laparoscopic partial splenectomy: a safe and feasible treatment for splenic benign lesions. Surg Laparosc Endosc Percutan Tech 28:287–290Google Scholar
  53. 53.
    Tiron A, Vasilescu C (2008) Role of the spleen in immunity. Immunologic consequences of splenectomy. Chirurgia (Bucur) 103:255–263Google Scholar
  54. 54.
    Vasilescu C, Stanciulea O, Tudor S et al (2006) Laparoscopic subtotal splenectomy in hereditary spherocytosis: to preserve the upper or the lower pole of the spleen? Surg Endosc 20:748–752CrossRefGoogle Scholar
  55. 55.
    Schilling RF (1997) Spherocytosis, splenectomy, strokes and heart attacks. Lancet 350:1677CrossRefGoogle Scholar
  56. 56.
    Mouttalib S, Rice HE, Snyder D et al (2012) Evaluation of partial and total splenectomy in children with sickle cell disease using an Internet-based registry. Pediatr Blood Cancer 59:100–104CrossRefGoogle Scholar
  57. 57.
    Ziske CG, Muller T (2002) Partial splenectomy: uses of error. Lancet 359:1144CrossRefGoogle Scholar
  58. 58.
    Redmond HP, Redmond JM, Rooney BP et al (1989) Surgical anatomy of the human spleen. Br J Surg 76:198–201CrossRefGoogle Scholar
  59. 59.
    Mackenzie RK, Youngson GG, Mahomed AA (2004) Laparoscopic decapsulation of congenital splenic cysts: a step forward in splenic preservation. J Pediatr Surg 39:88–90CrossRefGoogle Scholar
  60. 60.
    Schier F, Waag KL, Ure B (2007) Laparoscopic unroofing of splenic cysts results in a high rate of recurrences. J Pediatr Surg 42:1860–1863CrossRefGoogle Scholar
  61. 61.
    Mertens J, Penninckx F, DeWever I et al (2007) Long-term outcome after surgical treatment of nonparasitic splenic cysts. Surg Endosc 21:206–208CrossRefGoogle Scholar
  62. 62.
    Bader-Meunier B, Gauthier F, Archambaud F et al (2001) Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis. Blood 97:399–403CrossRefGoogle Scholar
  63. 63.
    Van Wyck DB, Witte MH, Witte CL et al (1980) Critical splenic mass for survival from experimental pneumococcemia. J Surg Res 28:14–17CrossRefGoogle Scholar
  64. 64.
    Szczepanik AB, Meissner AJ (2009) Partial splenectomy in the management of nonparasitic splenic cysts. World J Surg 33:852–856.  https://doi.org/10.1007/s00268-008-9868-2 CrossRefGoogle Scholar
  65. 65.
    Dutta S, Price VE, Blanchette V et al (2006) A laparoscopic approach to partial splenectomy for children with hereditary spherocytosis. Surg Endosc 20:1719–1724CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of the Second General SurgerySheng Jing Hospital of China Medical UniversityShenyang CityChina

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