Hand-assisted laparoscopic splenectomy (HALS) in cases of splenomegaly

Background: Laparoscopic splenectomy (LS) is considerably more difficult to perform when the spleen is enlarged. The new technique of hand-assisted designed technique aimed to assist laparoscopic surgery allows the surgeon to insert his or her hand into the abdomen while maintaining the pneumoperitoneum, thus recovering the tactile sensation lost in conventional laparoscopic surgery. Object: In this study, we compared the immediate results of conventional LS and hand-assisted LS (HALS) in cases of splenomegaly. Methods: Between February 1993 and August 2001, 200 LS were attempted at two university hospitals. In 56 cases, splenomegaly (final spleen weight >700 g) was observed clinically or detected on radiological examination. We compared the first 36 patients operated on by conventional LS (group I) with the last consecutive 20 patients, who underwent HALS (group II). The study parameters were operative time, conversion rate, transfusion rate, morbidity and length of hospital stay. Results: The groups were comparable in terms of age (58 ± 13 [ranges, l9–82] vs 58 ± 16 years [range, 44–84] (ns), diagnosis, and spleen weight (1425 ± 884 [range, 700–3400]) vs 1753 ± 1124 g [range, 720–4500] (ns). HALS was associated with less morbidity (36% vs 10%) (ns), a shorter operative time (177 ± 52 [range, 95–300]) vs 135 ± 53 min [range, 85–270] (p <0.009), and a shorter hospital stay (6.3 ± 3.3 [range, 3–14]) vs 4 ± 1.2 [range, 2–7] days (p <0.05). Conclusion: In cases of splenomegaly, HALS assisted laparoscopic surgery significantly facilitates the surgical maneuvers during LS while maintaining the advantages of a purely laparoscopic approach.