Abstract
Laparoscopic splenectomy in children has been shown to be safe, to reduce postoperative pain and hospital stay, and to accelerate return to full activities. We describe our experience with a four-port “lateral” approach in 18 patients. Patients were placed in the lateral decubitus position and the table was flexed to separate the left subcostal margin and iliac crest. The camera port was inserted at the umbilicus and additional ports were placed in the epigastrium and left lower quadrant. After mobilization of the splenic flexure a port was inserted in the left flank below the 12th rib for elevation of the spleen. A 30° laparoscope was used and the splenic vessels were controlled with an endo-GIA and/or clips. The spleens were placed in a bag, morcellated, and extracted through a port site. Eight females and 10 males with a median age of 12.5 years (5–17 years) and weight of 55.5 kg (17–124 kg) underwent splenectomy of idiopathic thrombocytopenia purpora (10), spherocytosis (6), elliptocytosis (1), and Hodgkin's disease (1). The median operating time was 160 min (90–300 min) and median blood loss was 105 ml (5–350 ml). Accessory spleens were removed in four cases. Three patients required extensions of a port site to remove large spleens which could not be placed in a bag. The sole complication was a transient pancreatitis with associated pleural effusion. The median postoperative hospital stay was 2 days (1–11 days) and time to full activities was 8 days (3–25 days). The lateral approach affords excellent visualization of the splenic vessels, pancreas, and accessory spleens. This approach is safe and reliable and is our preferred approach for laparoscopic splenectomy in children.
Similar content being viewed by others
References
Carroll BJ, Phillips EH, Semel CJ. Fallas M, Morgenstern L (1992) Laparoscopic splenectomy. Surg Endosc 6: 183–185
Delaitre B (1995) Laparoscopic splenectomy: the “hanged spleen” technique. Surg Endosc 9: 528–529
Flowers JL (1993) Laparoscopic splenectomy. In: Zucker KA (ed) Surgical laparoscopy update. Quality Medical, St Louis, pp 357–371
Gilchrist BF, Lobe TE, Schropp KP, Kay GA, Hixson SD, Wrenn EL, Philippe PG, Hollabaugh RS (1992) Is there a role for laparoscopic appendectomy in pediatric surgery? J Pediatr Surg 27(2): 209–12; discussion 212–214
Lefor AT, Melvin WS, Bailey RW. Flowers JL (1993) Laparoscopic splenectomy in the management of immune thrombocytopenia purpura. Surgery 114: 613–618
Lobe TE, Presbury GJ, Smith BM, Wilimas JA, Wang WC (1993) Laparoscopic splenectomy. Pediatr Ann 22(11): 671–674
Moores D, McKee M, Wang H, Fischer J. Andrews HG (1995) Pediatric laparoscopic splenectomy. J Pediatr Surg 30(8): 1201–1205
Park A, Gagner M (1994) The lateral approach to laparoscopic splenectomy. Surg Endosc 8(3): 239 (abstract)
Phillips EH, Carroll BJ, Fallas MJ (1994) Laparoscopic splenectomy. Surg Endosc 8:931–933
Poulin EC, Thibault C (1993) The anatomical basis for laparoscopic splenectomy. Can J Surg 36(5): 484–488
Poulin EC, Thibault C (1995) Laparoscopic splenectomy for massive splenomegaly: operative technique and case report. Can J Surg 38(1): 69–72
Poulin EC, Thibault C, Mamazza J (1995) Laparoscopic splenectomy. Surg Endosc 9: 172–177
Smith BM, Schropp KP, Lobe TE, Rogers DA, Presbury GJ, Wilimas JA, Wong WC (1994) Laparoscopic splenectomy in childhood. J Pediatr Surg 29(8): 975–977
Tulman S, Holcomb GW, Karamanoukian HL, Reynhout J (1993) Pediatric laparoscopic splenectomy. J Pediatr Surg 28: 689–692
Yoshida K, Yamazaki Y, Mizuno R, Shoji Y, Hara A, Yoshizawa J, Kabai M (1995) Laparoscopic splenectomy in children. Surg Endosc 9(2): 244 (Abstract)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fitzgerald, P.G., Langer, J.C., Cameron, B.H. et al. Pediatric laparoscopic splenectomy using the lateral approach. Surg Endosc 10, 859–861 (1996). https://doi.org/10.1007/BF00189553
Issue Date:
DOI: https://doi.org/10.1007/BF00189553