Laparoscopic cholecystectomy has been accepted as a safe procedure from all over the world. Many kinds of laparoscopy-aided procedures on the other organs are enabled by means of accumulated experiences and development of the devices. The scope
of
laparoscopic abdominal peration has stretched beyond the imagination, to the appendectomy, hernioorhaphy and even to gastrectomy or colectomy.
Splenectomy has traditionally been performed through a generous lapaarotomy incision, for its requiring complete mobilization of the spleen for removal. The spleen, with its known complex vasculature and peritoneal attachments, had been seemed to
defy
the feasibility of splenectomy by the laparoscopic approach until a few pioneers succeeded.
We attempted five cases of laparoscopic splenectomy from January 1994 to December 1994 Two women with immune thrombocytopenic purpura and a man with hereditary spherocytosis were managed entirely by laparoscopic means and other two cases had to
be
converted to oper surgery due to uncontrollable bleeding.
We laid the patient as right semi-decubitus position and, using five trocars, approached through the lesser sac, and tried to clip the vessels slighty apart from the spleen. At the superior side of the tail of the pancreas, we clipped splenic
artery
first, and let the blood that pooled in the spleen drain into the systemic circulation, in order to make the manupulation of the spleen easy, and to lessen intraoperative bleeding. We clipped veins right before severing posterior peritoneal
attachments.
After completion of disection, a plastic bag was introduced into the abdominal cavity and the freed spleen was slipped into the bag. The spleen was removed after morcellation with ring forceps through umbilical port which was widened about 1.5 to
2.0cm
in diameter.
The average duration of operation was 370 minutes(range: 240 to 495 minutes) and the hospital stay averaged 13 days(range: 7 to 22 days), Successful cases needed no transfusion, but one of two failed cases did need transfusion due to bleeding. No
serious complication was present during or after the operation, and the patients were satisfied with the result 1 to 7 months after the operation.
So far the safety of the laparoscopic splenectomy has been questionable. In selected cases, however, it may be fesible, proveded the surgeon is proficient in advanced techniques of intraabdominal endoscopic surgery. In the near furture,
laparoscopic
splenectomy can afford to be accepted as a usual procedure just like laparoscopic cholecystecomy, owing to various clinical benefits better than those of conventional splenectomy, with cumulating experiences.
Although this is the first report in Korea, the results are as dramatic as thr results of the laparoscopic cholecystectomy. We hope it be helpful for the endoscopic surgeons who want to widen the range of his ability on it.
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