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Partial splenectomy in the era of minimally invasive surgery: the current laparoscopic and robotic experiences

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Abstract

Background

Partial splenectomy (PS) is a spleen-preserving technique that is applied as a result of trauma, focal lesions or hematological conditions. Despite the improvement of laparoscopic techniques within the past several decades, minimally invasive PS has remained a marginal technique that has not been well evaluated. Our objective was to provide an update on the indications and the feasibility of this procedure.

Methods

The MEDLINE database (PubMed) was searched, and all relevant articles that involved a true minimally invasive PS (i.e., segmental or lobar devascularization of the spleen with parenchymal transection) were included. The search was conducted until the 31st of March 2014. Demographic data, operative indications, estimated blood losses, operative times, conversion rates and complications were extracted from the included articles and were summarized for discussion.

Results

Out of the 195 publications that were retrieved, 33 were included, which were mainly case reports and case series that represented a total of 187 patients. There were 37 men, 33 women and 117 patients of unknown gender. The mean age of the patients was ranged from 6 to 58 years. The mean total operative time was between 70 and 216 min for conventional laparoscopy and between 108 and 120 min for the robotic approach. For most studies, the mean estimated blood loss was minimal. The complication rate was 5.36 % for conventional laparoscopy and 5.56 % for the robotic approach.

Conclusion

The outcomes of minimally invasive PS were favorable and comparable to those of the open technique according to the literature. This procedure may constitute an attractive alternative to the open technique for selected cases. Moreover, a robotic approach might be an interesting technical option, but additional research is needed before any definitive conclusions can be drawn.

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Abbreviations

LPS:

Laparoscopic partial splenectomy

OPSI:

Overwhelming post-splenectomy infection

PS:

Partial splenectomy

RPS:

Robotic partial splenectomy

SSPS:

Single-site access partial splenectomy

References

  1. Hansen K, Singer DB (2001) Asplenic–hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol 4:105–121

    Article  CAS  PubMed  Google Scholar 

  2. Breitenstein S, Scholz T, Schafer M, Decurtins M, Clavien PA (2007) Laparoscopic partial splenectomy. J Am Coll Surg 204:179–181

    Article  PubMed  Google Scholar 

  3. Di Sabatino A, Carsetti R, Corazza GR (2011) Post-splenectomy and hyposplenic states. Lancet 378:86–97

    Article  PubMed  Google Scholar 

  4. Hoeper MM, Niedermeyer J, Hoffmeyer F, Flemming P, Fabel H (1999) Pulmonary hypertension after splenectomy? Ann Intern Med 130:506–509

    Article  CAS  PubMed  Google Scholar 

  5. Jais X, Ioos V, Jardim C, Sitbon O, Parent F, Hamid A, Fadel E, Dartevelle P, Simonneau G, Humbert M (2005) Splenectomy and chronic thromboembolic pulmonary hypertension. Thorax 60:1031–1034

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Hassn AM, Al-Fallouji MA, Ouf TI, Saad R (2000) Portal vein thrombosis following splenectomy. Br J Surg 87:362–373

    Article  PubMed  Google Scholar 

  7. Karakantza M, Theodorou GL, Mouzaki A, Theodori E, Vagianos C, Maniatis A (2004) In vitro study of the long-term effects of post-traumatic splenectomy on cellular immunity. Scand J Immunol 59:209–219

    Article  CAS  PubMed  Google Scholar 

  8. Rodeghiero F, Ruggeri M (2012) Short- and long-term risks of splenectomy for benign haematological disorders: should we revisit the indications? Br J Haematol 158:16–29

    Article  PubMed  Google Scholar 

  9. Kimura F, Ito H, Shimizu H, Togawa A, Otsuka M, Yoshidome H, Shimamura F, Kato A, Nukui Y, Ambiru S, Miyazaki M (2003) Partial splenic embolization for the treatment of hereditary spherocytosis. AJR Am J Roentgenol 181:1021–1024

    Article  PubMed  Google Scholar 

  10. Vasilescu C, Stanciulea O, Tudor S (2012) Laparoscopic versus robotic subtotal splenectomy in hereditary spherocytosis. Potential advantages and limits of an expensive approach. Surg Endosc 26:2802–2809

    Article  PubMed  Google Scholar 

  11. Alvarez FE, Greco RS (1980) Regeneration of the spleen after ectopic implantation and partial splenectomy. Arch Surg 115:772–775

    Article  CAS  PubMed  Google Scholar 

  12. Christo MC, DiDio LJ (1997) Anatomical and surgical aspects of splenic segmentectomies. Ann Anat 179:461–474

    Article  CAS  PubMed  Google Scholar 

  13. Christo MC (1959) Partial regulated splenectomies. Preliminary note on the first 3 cases operated on. Hospital 56:645–650

    CAS  Google Scholar 

  14. Morgenstern L, Shapiro SJ (1980) Partial splenectomy for nonparasitic splenic cysts. Am J Surg 139:278–281

    Article  CAS  PubMed  Google Scholar 

  15. Poulin EC, Thibault C, DesCoteaux JG, Cote G (1995) Partial laparoscopic splenectomy for trauma: technique and case report. Surg Laparosc Endosc 5:306–310

    CAS  PubMed  Google Scholar 

  16. Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E (2008) Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 22:821–848

    Article  CAS  PubMed  Google Scholar 

  17. Uranues S, Alimoglu O (2005) Laparoscopic surgery of the spleen. Surg Clin N Am 85:75–90

    Article  PubMed  Google Scholar 

  18. Hery G, Becmeur F, Mefat L, Kalfa D, Lutz P, Lutz L, Guys JM, de Lagausie P (2008) Laparoscopic partial splenectomy: indications and results of a multicenter retrospective study. Surg Endosc 22:45–49

    Article  PubMed  Google Scholar 

  19. Hong TH, Lee SK, You YK, Kim JG (2010) Single-port laparoscopic partial splenectomy: a case report. Surg Laparosc Endosc Percutan Tech 20:e164–e166

    Article  PubMed  Google Scholar 

  20. Giulianotti PC, Buchs NC, Coratti A, Sbrana F, Lombardi A, Felicioni L, Bianco FM, Addeo P (2011) Robot-assisted treatment of splenic artery aneurysms. Ann Vasc Surg 25:377–383

    Article  PubMed  Google Scholar 

  21. Slater BJ, Chan FP, Davis K, Dutta S (2010) Institutional experience with laparoscopic partial splenectomy for hereditary spherocytosis. J Pediatr Surg 45:1682–1686

    Article  PubMed  Google Scholar 

  22. Kimber C, Spitz L, Drake D, Kiely E, Westaby S, Cozzi F, Pierro A (1998) Elective partial splenectomy in childhood. J Pediatr Surg 33:826–829

    Article  CAS  PubMed  Google Scholar 

  23. Gamme G, Birch DW, Karmali S (2013) Minimally invasive splenectomy: an update and review. Can J Surg 56:280–285

    Article  PubMed Central  PubMed  Google Scholar 

  24. Bader-Meunier B, Gauthier F, Archambaud F, Cynober T, Mielot F, Dommergues JP, Warszawski J, Mohandas N, Tchernia G (2001) Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis. Blood 97:399–403

    Article  CAS  PubMed  Google Scholar 

  25. Tchernia G, Bader-Meunier B, Berterottiere P, Eber S, Dommergues JP, Gauthier F (1997) Effectiveness of partial splenectomy in hereditary spherocytosis. Curr Opin Hematol 4:136–141

    Article  CAS  PubMed  Google Scholar 

  26. Stoehr GA, Stauffer UG, Eber SW (2005) Near-total splenectomy: a new technique for the management of hereditary spherocytosis. Ann Surg 241:40–47

    PubMed Central  PubMed  Google Scholar 

  27. Szczepanik AB, Meissner AJ (2009) Partial splenectomy in the management of nonparasitic splenic cysts. World J Surg 33:852–856

    Article  PubMed  Google Scholar 

  28. Morinis J, Dutta S, Blanchette V, Butchart S, Langer JC (2008) Laparoscopic partial vs total splenectomy in children with hereditary spherocytosis. J Pediatr Surg 43:1649–1652

    Article  PubMed  Google Scholar 

  29. Godiris-Petit G, Goasguen N, Munoz-Bongrand N, Cattan P, Sarfati E (2007) Laparoscopic partial splenectomy using the Harmonic Scalpel. Two case reports. J Chir 144:339–341

    Article  CAS  Google Scholar 

  30. Vasilescu C, Tudor S, Popa M, Tiron A, Lupescu I (2010) Robotic partial splenectomy for hydatid cyst of the spleen. Langenbeck’s Arch Surg 395:1169–1174

    Article  Google Scholar 

  31. Hollingsworth CL, Rice HE (2010) Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging. Pediatr Radiol 40:1177–1183

    Article  PubMed  Google Scholar 

  32. Pietrabissa A, Morelli L, Ferrari M, Peri A, Ferrari V, Moglia A, Pugliese L, Guarracino F, Mosca F (2010) Mixed reality for robotic treatment of a splenic artery aneurysm. Surg Endosc 24:1204

    Article  PubMed  Google Scholar 

  33. Budzynski A, Demczuk S, Kumiega B, Migaczewski M, Matlok M, Zub-Pokrowiecka A (2011) Sclerosing angiomatoid nodular transformation of the spleen treated by laparoscopic partial splenectomy. Wideochir Inne Tech Malo Inwazyjne 6:249–255

    PubMed Central  PubMed  Google Scholar 

  34. Corcione F, Cuccurullo D, Caiazzo P, Settembre A, Bruzzese G, Vittoria I, Cusano T (2003) Laparoscopic partial splenectomy for a splenic pseudocyst. Surg Endosc 17:1850

    CAS  PubMed  Google Scholar 

  35. Czauderna P, Vajda P, Schaarschmidt K, Kalman A, Jainsch M, Engelis A, Lewicki K, Verebely T, Koltai J, Petersons A, Pinter AB (2006) Nonparasitic splenic cysts in children: a multicentric study. Eur J Pediatr Surg 16:415–419

    Article  CAS  PubMed  Google Scholar 

  36. De Greef E, Hoffman I, Topal B, Broers C, Miserez M (2008) Partial laparoscopic splenectomy for splenic abscess because of Salmonella infection: a case report. J Pediatr Surg 43:E35–E38

    Article  PubMed  Google Scholar 

  37. Dutta S, Price VE, Blanchette V, Langer JC (2006) A laparoscopic approach to partial splenectomy for children with hereditary spherocytosis. Surg Endosc 20:1719–1724

    Article  CAS  PubMed  Google Scholar 

  38. Fan H, Zhang D, Zhao X, Pan F, Jin ZK (2011) Laparoscopic partial splenectomy for large splenic epidermoid cyst. Chin Med J 124:1751–1753

    PubMed  Google Scholar 

  39. Iimuro Y, Okada T, Sueoka H, Hai S, Kondo Y, Suzumura K, Fujimoto J (2013) Laparoscopic management of giant splenic true cyst with partial splenectomy: a case report. Asian J Endosc Surg 6:226–230

    Article  PubMed  Google Scholar 

  40. Jain P, Parelkar S, Shah H, Sanghvi B (2008) Laparoscopic partial splenectomy for splenic epidermoid cyst. J Laparoendosc Adv Surg Tech A 18:899–902

    Article  PubMed  Google Scholar 

  41. Khelif K, Maassarani F, Dassonville M, Laet MH (2006) Laparoscopic partial splenectomy using radiofrequency ablation for nonparasitic splenic cysts in two children. J Laparoendosc Adv Surg Tech A 16:414–417

    Article  PubMed  Google Scholar 

  42. Okano K, Kakinoki K, Suto H, Oshima M, Akamoto S, Hagiike M, Usuki H, Suzuki Y (2011) Hand-assisted laparoscopic partial splenectomy using an endopath monopolar sealer. Surg Laparosc Endosc Percutan Tech 21:e291–e294

    Article  PubMed  Google Scholar 

  43. Patrzyk M, Glitsch A, Hoene A, von Bernstorff W, Heidecke CD (2011) Laparoscopic partial splenectomy using a detachable clamp with and without partial splenic embolisation. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie 396:397–402

    Article  PubMed  Google Scholar 

  44. Petroianu A, Cabezas-Andrade MA, Berindoague Neto R (2008) Laparoscopic subtotal splenectomy. Surg Laparosc Endosc Percutan Tech 18:94–97

    Article  PubMed  Google Scholar 

  45. Rescorla FJ, West KW, Engum SA, Grosfeld JL (2007) Laparoscopic splenic procedures in children: experience in 231 children. Ann Surg 246:683-687 (discussion 687-688)

  46. Schwetling R, Anders S, Barlehner E (1997) Laparoscopic splenic surgery–report of 17 personal cases. Zentralbl Chir 122:291–294

    CAS  PubMed  Google Scholar 

  47. Seims AD, Breckler FD, Hardacker KD, Rescorla FJ (2013) Partial versus total splenectomy in children with hereditary spherocytosis. Surgery 154:849–853 (discussion 853-845)

  48. Seshadri PA, Poulin EC, Mamazza J, Schlachta CM (2000) Technique for laparoscopic partial splenectomy. Surg Laparosc Endosc Percutan Tech 10:106–109

    CAS  PubMed  Google Scholar 

  49. Smith ST, Scott DJ, Burdick JS, Rege RV, Jones DB (2001) Laparoscopic marsupialization and hemisplenectomy for splenic cysts. J Laparoendosc Adv Surg Tech A 11:243–249

    Article  CAS  PubMed  Google Scholar 

  50. Uranues S, Grossman D, Ludwig L, Bergamaschi R (2007) Laparoscopic partial splenectomy. Surg Endosc 21:57–60

    Article  CAS  PubMed  Google Scholar 

  51. Vasilescu C, Stanciulea O, Tudor S, Stanescu D, Colita A, Stoia R, Coriu D, Colita A, Arion C (2006) Laparoscopic subtotal splenectomy in hereditary spherocytosis : to preserve the upper or the lower pole of the spleen? Surg Endosc 20:748–752

    Article  CAS  PubMed  Google Scholar 

  52. Vasilescu C, Stanciulea O, Popa M, Colita A, Arion C (2008) Subtotal laparoscopic splenectomy and esophagogastric devascularization for the thrombocytopenia because of portal cavernoma–case report. J Pediatr Surg 43:1373–1375

    Article  PubMed  Google Scholar 

  53. Wang J, Yu JC, Kang WM, Ma ZQ (2010) Laparoscopic partial splenectomy for giant hemangioma misdiagnosed as splenic cyst: a case report. Chin Med Sci J 25:189–192

    Article  PubMed  Google Scholar 

  54. Giulianotti PC, Buchs NC, Addeo P, Ayloo S, Bianco FM (2011) Robot-assisted partial and total splenectomy. Int J Med Robot Comput Assist Surg 7:482–488

    Article  Google Scholar 

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Disclosures

Drs. Alexandre Balaphas, Nicolas C. Buchs, Jeremy Meyer and Prof. Philippe Morel have no conflicts of interest or financial ties to disclose. Dr. Monika Hagen is a consultant for Intuitive Surgical International.

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Balaphas, A., Buchs, N.C., Meyer, J. et al. Partial splenectomy in the era of minimally invasive surgery: the current laparoscopic and robotic experiences. Surg Endosc 29, 3618–3627 (2015). https://doi.org/10.1007/s00464-015-4118-9

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  • DOI: https://doi.org/10.1007/s00464-015-4118-9

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