Laparoscopic splenectomy in massive splenomegaly

Background: Laparoscopy for splenectomy will mainly be used in normal sized hematologic diseases. Massive splenomegaly used to be viewed as a contraindication for laparoscopic splenectomy (LS). This paper reviews current options for laparoscopic surgery on the enlarged spleen, and summarizes the results. Methods: Minimally invasive surgery for splenomegaly may use laparoscopy alone or a hand-assisted technique (HALS). HALS uses an accessory incision (7-7.5 cm), usually in the right hypogastrium, for the insertion of a hand. Results: Refined techniques and instruments allow successful management of an enlarged spleen, either by LS alone or HALS, without sacrificing any of the advantages of a minimally invasive procedure, but the best approach is controversial. Cumulative results show that operative time, blood loss, and length of hospitalization are significantly reduced with both HALS and LS alone. Conclusions: Splenomegaly is not a contraindication for the laparoscopic approach; however, it is an advanced procedure and surgeons attempting it must be thoroughly familiar with hand-assisted techniques. Comparative studies are needed to determine the real value of laparoscopy in massive splenomegaly. © Springer-Verlag 2006.