ABSTRACT
In 1991 and 1992 European, North American, and Japanese centers published the first reports of laparoscopic splenectomy [1-4]. It was the hope of these pioneers that patients would ultimately realize the similar benefits of shortened hospital stays, less pain, and improved cosmesis that were demonstrated with other laparoscopic procedures such as laparoscopic cholecystectomy and laparoscopic appendectomy. The early accounts of laparoscopic splenectomy consistently pointed out the technical difficulties encountered by surgeons using rudimentary laparoscopic instruments to dissect and manipulate such a vascular and fragile structure. Over time, technical advances-including the use of ultrasonic dissectors, endoscopic vascular stapling devices, and adoption by most surgeons of the lateral approach to laparoscopic splenectomy-have shortened operative times and decreased complications. Although there are no prospective, randomized trials comparing open and laparoscopic splenectomy, a number of retrospective and case studies provide evidence that laparoscopic splenectomy results in shorter hospital stays and fewer complications than open surgery [5-7]. I think it is safe to say that laparoscopic splenectomy is the procedure of choice for the removal of all but the most massively enlarged spleens [8]. Despite the advantages that laparoscopic splenectomy offers, the procedure presents technical challenges due to the vascular nature and frail texture of the spleen. The close
TABLE 1 Complications of Laparoscopic Splenectomy
with the specific features of the hematological diseases for which the splenectomy is being done (thrombocytopenia and malignancy to name a few)—contributes to postoperative morbidity, which is largely technique-related [9]. It is with this in mind that this chapter attempts to address the measures one must take to minimize the intraoperative and postoperative complications of laparoscopic splenectomy and the means to manage them should they occur (Table 1).
