Abstract
Minimally invasive approaches have gradually evolved to become the golden standard in several surgical procedures. Laparoscopic splenectomy has been performed for several years offering similar or even better results compared to open surgery. Approaches in laparoscopic splenectomy regarding the positioning of the patient and the operative procedure still vary in the literature. Several new techniques and combinations of the existing methods are currently evaluated in an effort to overcome contraindications and offer optimum results in terms of safety, effectiveness and postoperative quality of life. This study aims to review the different approaches of minimal invasive splenectomy with specific emphasis on the technical issues of lateral and anterior laparoscopic, hand assisted, single port laparoscopic, robotic and transluminal endoscopic techniques.
Similar content being viewed by others
References
Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med. 1991;20:2263.
Winslow ER, Brunt LM. Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery. 2003 Oct;134(4):647–653
Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008 Apr;22(4):821–848.
Agarwal N. Laparoscopic splenectomy in a case of blunt abdominal trauma. J Minim Access Surg. 2009 Jul–Sep;5(3):78–81.
Basso N, Silecchia G, Raparelli L, Pizzuto G, Picconi T. Laparoscopic splenectomy for ruptured spleen: lessons learned from a case. J Laparoendosc Adv Surg Tech A. 2003 Apr;13(2):109–112.
Obuchi T, Sasaki A, Nakajima J, Nitta H, Otsuka K, Wakabayashi G. Laparoscopic surgery for splenic artery aneurysm. Surg Laparosc Endosc Percutan Tech. 2009 Aug 19(4):338–340.
Uraneus S, Grossman D, Ludwig L, et al. Laparoscopic partialsplenectomy. Surg Endosc. 2007;21:57–60.
Poulin E, Thibault C, Mamazza J, Girotti M, Cote G, Renaud A Laparoscopic splenectomy: clinical experience and the role of preoperative splenic artery embolization. Surg Laparosc Endosc 1993;3:445–450
Iwase K, Higaki J, Mikata S, Tanaka Y, Yoshikawa M, Hori S, Osuga K, Kosugi S, Tamaki T, Kamiike W. Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly. Surg Laparosc Endosc Percutan Tech 1999;9:197–202
Naoum JJ, Silberfein EJ, Zhou W, Sweeney JF, Albo D, Brunicardi FC, Kougias P, El Sayed HF, Lin PH. Concomitant intraoperative splenic artery embolization and laparoscopic splenectomy versus laparoscopic splenectomy: comparison of treatment outcome. Am J Surg 2007;193:713–718
Delaitre B, Bonnichon P, Barthes T, et al. Laparoscopic splenectomy. The “hanging spleen technique” in a series of nineteen cases. Ann Chir. 1995;49:471–476.
Park A, Gagner M, Pomp A. The lateral approach to laparoscopic splenectomy. Am J Surg 1997;173:126–130
Kollias J, Watson DI, Coventry BJ, Malycha P. Laparoscopic splenectomy using the lateral position: an improved technique. Aust N Z J Surg. 1995 Oct;65(10):746–748.
Romano F, Caprotti R, Franciosi C, De Fina S, Colombo G, Sartori P, Uggeri F. The use of LigaSure during pediatric laparoscopic splenectomy: a preliminary report. Pediatr Surg Int 2003;19:721–724
Gelmini R, Romano F, Quaranta N, Caprotti R, Tazzioli G, Colombo G, Saviano M, Uggeri F. Sutureless and stapleless laparoscopic splenectomy using radiofrequency: LigaSure device. Surg Endosc 2006;20:991–994
Rothenberg SS. Laparoscopic splenectomy using the harmonic scalpel. J Laparoendosc Surg 1996;6(Suppl 1):S61–63
Schaarschmidt K, Kolberg-Schwerdt A, Lempe M, Saxena A. Ultrasonic shear coagulation of main hilar vessels: a 4-year experience of 23 pediatric laparoscopic splenectomise without staples. J Pediatr Surg 2002;37:614–616
Yüney E, Hobek A, Keskin M, Yilmaz O, Kamali S, Oktay C, Bender O. Laparoscopic splenectomy and LigaSure. Surg Laparosc Endosc Percutan Tech 2 2005;15:212–215
Romano F, Caprotti R, Franciosi C, De Fina S, Colombo G, Uggeri F. Laparoscopic splenectomy using Ligasure: preliminary experience. Surg Endosc 2002;16:1608–1611
Park A, Targarona EM, Trias M. Laparoscopic surgery of the spleen: state of the art. Langenbecks Arch Surg. 2001 Apr;386(3):230–239. Review.
Rudowski WJ. Accessory spleens: clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura. World J Surg. 1985 Jun;9(3):422–430
Terrosu G, Donini A, Silvestri F, Petri R, Anania G, Barillari G, Baccarani U, Risaliti A, Bresadola F. Laparoscopic splenectomy in the management of hematological diseases: surgical technique and outcome of 17 patients. Surg Endosc 1996;10:441–444
Trias M, Targarona EM, Moral A, Prados M. Laparoscopic splenectomy: technical aspects and preliminary results. Endosc Surg Allied Technol 1994;2:288–292
Donini A, Baccarani U, Terrosu G, Corno V, Ermacora A, Pasqualucci A, Bresadola F. Laparoscopic vs open splenectomy in the management of hematologic diseases. Surg Endosc 1999;13:1220–1225
Trias M, Targarona EM, Balague C. Laparoscopic splenectomy: an evolving technique: a comparison between anterior and lateral approaches. Surg Endosc 1996;10:389–392
Casaccia M, Torelli P, Squarcia S, Sormani MP, Savelli A, Troilo B, Santori G, Valente U. Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS). Surg Endosc 2006;20:1214–1220
Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda L, Capasso P, Piccolboni D. Technical standardization of laparoscopic splenectomy: experience with 105 cases. Surg Endosc. 2002 Jun;16(6):972–974.
Kucuk C, Sozuer E, Ok E, Altuntas F, Yilmaz Z. Laparoscopic versus open splenectomy in the management of benign and malign hematologic diseases: a ten-year single-center experience. J Laparoendosc Adv Surg Tech A 2005;15:135–139
Vecchio R, Cacciola E, Lipari G, Privitera V, Polino C, Cacciola R. Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura. JSLS 2005;9:415–418
Berends FJ, Schep N, Cuesta MA, Bonjer HJ, Kappers-Klunne MC, Huijgens P, Kazemier G. Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case-control study. Surg Endosc 2004;18:766–770
Tanoue K, Okita K, Akahoshi T, Konishi K, Gotoh N, Tsutsumi N, Tomikawa M, Hashizume M. Laparoscopic splenectomy for hematologic diseases. Surgery 2002;131:S318–S323
Franciosi C, Caprotti R, Romano F, Porta G, Real G, Colombo G, Uggeri F. Laparoscopic versus open splenectomy: a comparative study. Surg Laparosc Endosc Percutan Tech 2000;10:291–295
Chowbey PK, Goel A, Panse R, Sharma A, Khullar R, Soni V, Baijal M. Laparoscopic splenectomy for hematologic disorders: experience with the first fifty patients J Laparoendosc Adv Surg Tech A. 2005 Feb;15(1):28–32.
Konstadoulakis MM, Lagoudianakis E, Antonakis PT, Albanopoulos K, Gomatos I, Stamou KM, Leandros E, Manouras A. Laparoscopic versus open splenectomy in patients with beta thalassemia major. J Laparoendosc Adv Surg Tech A 2006;16:5–8
Donini A, Baccarani U, Terrosu G, Corno V, Ermacora A, Pasqualucci A, Bresadola F. Laparoscopic vs open splenectomy in the management of hematologic diseases. Surg Endosc 1999;13:1220–1225
Boddy AP, Mahon D, Rhodes M. Does open surgery continue to have a role in elective splenectomy? Surg Endosc 2006;20:1094–1098
Watanabe Y, Horiuchi A, Yoshida M, Yamamoto Y, Sugishita H, Kumagi T, Hiasa Y, Kawachi K. Significance of laparoscopic splenectomy in patients with hypersplenism. World J Surg 2007;31:549–555
Owera A, Hamade AM, Bani Hani OI, Ammori BJ. Laparoscopic versus open splenectomy for massive splenomegaly: a comparative study. J Laparoendosc Adv Surg Tech A 2006;16:241–246
Targarona EM, Espert JJ, Bombuy E, Vidal O, Cerdan G, Artigas V, Trias M. Complications of laparoscopic splenectomy. Arch Surg. 2000;135(10):1137–1140.
Goldstone J. Splenectomy for massive splenomegaly. Am J. Surg 1978;135:385–388
Walsh RM, Chand B, Brodsky J, Heniford BT. Determination of intact splenic weight based on morcellated weight. Surg Endosc 2003;17:1266–1268
Pugliese R, Sansonna F, Scandroglio I, Maggioni D, Ferrari GC, Di Lernia S, Costanzi A, Grillo Cimbanassi S, Chiara O. Laparoscopic splenectomy: a retrospective review of 75 cases. Int Surg 2006;91:82–86
Heniford BT, Park A, Walsh RM, Kercher KW, Matthews BD, Frenette G, Sing RF. Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: does size matter? Am Surg 2001;67:854–858
Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, O’Rourke N, Nathanson L, Fielding G. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg. 2003 Aug;238(2):235–240.
Mahon D, Rhodes M. Laparoscopic splenectomy: size matters. Ann R Coll Surg Engl 2003;85:248–251
Borrazzo EC, Daly JM, Morrisey KP, Fischer E, Belmont M, Hogle NJ, Fowler DL. Hand-assisted laparoscopic splenectomy for giant spleens. Surg Endosc. 2003 Jun;17(6):918–920.
Kercher KW, Matthews BD, Walsh RM, Sing RF, Backus CL, Heniford BT. Laparoscopic splenectomy for massive splenomegaly. Am J Surg 2002;183:192–196
Boddy AP, Mahon D, Rhodes M. Does open surgery continue to have a role in elective splenectomy? Surg Endosc. 2006;20(7):1094–1098.
Targarona EM, Balagué C, Trias M. Is the laparoscopic approach reasonable in cases of splenomegaly? Semin Laparosc Surg. 2004 S;11(3):185–190
Targarona FM, Espert IJ, Balague C, Piulachs J, Artigas V, Trias M. Splenomegaly should not be contraindication for laparoscopic splenomegaly. Ann Surg 1998;228:35–39.
Romanelli JR, Kelly JJ, Litwin DE. Hand-assisted laparoscopic surgery in the United States: an overview. Semin Laparosc Surg. 2001;8(2):96–103.
Kusminsky RE, Boland JP, Tiley EH, Deluca JA. Hand assisted laparoscopic splenectomy. Surg Laparosc Endosc 1995;5:463–467
Maartense S, Bemelman WA, Gerritsen van der Hoop A, Meijer DW, Gouma DJ. Hand-assisted laparoscopic surgery (HALS): a report of 150 procedures. Surg Endosc. 2004;18(3):397–401
Bemelman WA, de Wit LT, Busch OR, Gouma DJ Hand-assisted laparoscopic splenectomy. Surg Endosc. 2000;14(11):997–998.
Meijer DW, Gossot D, Jakimowicz JJ, De Wit LT, Bannenberg JJ, Gouma DJ. Splenectomy revised: manually assisted splenectomy with the dexterity device—a feasibility study in 22 patients. J Laparoendosc Adv Surg Tech A. 1999;9(6):507–510.
Hellman P, Arvidsson D, Rastad J. HandPort-assisted laparoscopic splenectomy in massive splenomegaly. Surg Endosc 2000;14:1177–1179
Borrazzo EC, Daly JM, Morrisey KP, Fischer E, Belmont M, Hogle NJ, Fowler DL. Hand-assisted laparoscopic splenectomy for giant spleens. Surg Endosc 2003;17:918–920
Targarona EM, Balague C, Cerdan G, Espert JJ, Lacy AM, Visa J, Trias M. Hand-assisted laparoscopic splenectomy (HALS) in cases of splenomegaly: a comparison analysis with conventional laparoscopic splenectomy. Surg Endosc 2002;16:426–430
Kaban GK, Czerniach DR, Cohen R, Novitsky YW, Yood SM, Perugini RA, Kelly JJ, Litwin DE. Hand-assisted laparoscopic splenectomy in the setting of splenomegaly. Surg Endosc 2004;18:1340–1343
Ailawadi G, Yahanda A, Dimick JB, Bedi A, Mulholland MW, Colletti L, Sweeney JF. Hand-assisted laparoscopic splenectomy in patients with splenomegaly or prior upper abdominal operation. Surgery 2002;132:689–696
Rosen M, Brody F, Walsh RM, Ponsky J. Hand-assisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly. Arch Surg 2002;137:1348–1352
Barbaros U, Dinçça A, Sümer A, Vecchio R, Rusello D, Randazzo V, Issever H, Avci C. Prospective randomized comparison of clinical results between hand-assisted laparoscopic and open splenectomies. Surg Endosc. 2010;24(1):25–32.
Leandros E, Alexakis N, Albanopoulos K, Dardamanis D, Karagiorga M, Gomatos I, Papadopoulos S, Bacoyiannis C, Bramis J. Hand-assisted laparoscopic surgery with a Pfannenstiel incision in beta-thalassemia patients: initial experience. World J Surg. 2006;30(7):1216–1220
Laopodis V, Kritikos E, Rizzoti L, Stefanidis P, Klonaris P, Tzardis P. Laparoscopic splenectomy in beta-thalassemia major patients. Advantages and disadvantages. Surg Endosc. 1998;12(7):944–947.
Stamou KM, Toutouzas KG, Kekis PB, Nakos S, Gafou A, Manouras A, Krespis E, Katsaragakis S, Bramis J. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg. 2006;141(7):663–669.
Targarona EM, Balague C, Martinez C, Pallares L, Estalella L, Trias M. Single-port access: a feasible alternative to conventional laparoscopic splenectomy. Surg Innov. 2009;16(4):348–352.
Targarona EM, Pallares JL, Balague C, Luppi CR, Marinello F, Hernαndez P, Martınez C, Trias M. Single incision approach for splenic diseases: a preliminary report on a series of 8 cases. Surg Endosc. 2010;23. [Epub ahead of print]
Bodner J, Lucciarini P, Fish J, Kafka-Ritsch R, Schmid T. Laparoscopic splenectomy with the da Vinci robot. J Laparoendosc Adv Surg Tech A. 2005;15(1):1–5.
Targarona EM, Gomez C, Rovira R, Pernas JC, Balague C, Guarner-Argente C, Sainz S, Trias M. NOTES-assisted transvaginal splenectomy: the next step in the minimally invasive approach to the spleen. Surg Innov. 2009;16(3):218–222.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Albanopoulos, K., Dardamanis, D., Alexakis, N. et al. Minimally invasive approaches in splenic surgery. Hellenic J Surg 82, 342–351 (2010). https://doi.org/10.1007/s13126-010-0054-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13126-010-0054-2