Skip to main content

Advertisement

Log in

Prospective randomized comparison of clinical results between hand-assisted laparoscopic and open splenectomies

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although some studies have compared laparoscopic and hand-assisted laparoscopic splenectomy (HALS) in splenomegaly cases, no study has analyzed the differences between HALS and open splenectomy (OS). This study aimed to compare the HALS and OS techniques in splenomegaly cases.

Methods

This prospective study included 27 patients undergoing splenectomy for splenic disorders at the Department of General Surgery, Istanbul Medical Faculty between February and October 2007. Open splenectomy was performed for 14 patients and HALS for the remaining 13 patients.

Results

The end points compared included incision length, operative time, intraoperative blood loss, postoperative drain output and duration, postoperative pain scores, length of postoperative hospitalization, and perioperative complications. The authors found benefits of HALS over OS for incision length, postoperative pain score, postoperative drain output and duration, and hospital stay. The main advantages of the HALS technique over OS were less postoperative pain (p = 0.0002), shorter hospital stay (p = 0.004), and shorter abdominal incision (p = 0.012).

Conclusions

For splenomegaly, HALS significantly facilitates the surgical procedure and reduces the hospital stay while maintaining the advantages of OS such as tactile sense as well as easy and atraumatic manipulation of enlarged spleens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Khoursheed M, Al-Sayegh F, Al-Bader I, Kanawati N, Maroof R, Asfar S, Dashti H (2004) Laparoscopic splenectomy for hematological disorders. Med Princ Pract 13(3):122–125

    Article  CAS  PubMed  Google Scholar 

  2. Nakamura T, Kokuba Y, Mitomi H, Onozato W, Hatate K, Satoh T, Ozawa H, Ihara A, Watanabe M (2007) Comparison between the oncologic outcome of laparoscopic surgery and open surgery for T1 and T2 rectosigmoidal and rectal carcinoma: matched case-control study. Hepatogastroenterology 54:1094–1097

    PubMed  Google Scholar 

  3. Palanivelu C, Rangarajan M, Parthasarathi R, Senthilkumar R (2007) Laparoscopic resection for benign tumors of the stomach. JSLS 11:81–86

    PubMed  Google Scholar 

  4. Wilhelm TJ, Refeidi A, Palma P, Neufang T, Post S (2006) Hand-assisted laparoscopic sigmoid resection for diverticular disease: 100 consecutive cases. Surg Endosc 20:477–481

    Article  CAS  PubMed  Google Scholar 

  5. Kaban GK, Czerniach DR, Litwin DE, Litwin DE (2003) Hand-assisted laparoscopic surgery (review). Surg Technol Int 11:63–70

    PubMed  Google Scholar 

  6. Maartense S, Bemelman WA, Gerritsen Van Der Hoop A, Meijer DW, Gouma DJ (2004) Hand-assisted laparoscopic surgery (HALS): a report of 150 procedures. Surg Endosc 18:397–401

  7. Chowbey PK, Goel A, Panse R, Sharma A, Khullar R, Soni V, Baijal M (2005) Laparoscopic splenectomy for hematologic disorders: experience with the first fifty patients. J Laparoendosc Adv Surg Tech A 15:28–32

    Article  PubMed  Google Scholar 

  8. Knauer EM, Ailawadi G, Yahanda A, Obermeyer RJ, Millie MP, Ojeda H, Mulholland MW, Colletti L, Sweeney JF (2003) 101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders. Am J Surg 186:500–504

    Article  PubMed  Google Scholar 

  9. Kaban GK, Czerniach DR, Cohen R, Novitsky YW, Yood SM, Perugini RA, Kelly JJ, Litwin DE (2004) Hand-assisted laparoscopic splenectomy in the setting of splenomegaly. Surg Endosc 18:1340–1343

    Article  CAS  PubMed  Google Scholar 

  10. Aronson WL, Mcauliffe MS, Miller K (2003) Variability in the American society of Anesthesiologists Physical Status Classification Scale. AANA J 71:265–274

    PubMed  Google Scholar 

  11. Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236

    Article  CAS  PubMed  Google Scholar 

  12. Delaitre B, Maignien B (1991) Splenectomy by the laparoscopic approach: report of a case. Presse Med 20:2263

    CAS  PubMed  Google Scholar 

  13. Grahn SW, Alvarez J III, Kirkwood K (2006) Trends in laparoscopic splenectomy for massive splenomegaly. Arch Surg 141:755–761

    Article  PubMed  Google Scholar 

  14. Targarona EM, Balague C, Trias M (2004) Is the laparoscopic approach reasonable in cases of splenomegaly? (review). Semin Laparosc Surg 11:185–190

    PubMed  Google Scholar 

  15. Targarona EM, Espert JJ, Balague C, Piulachs J, Artigas V, Trias M (1998) Splenomegaly should not be considered a contraindication for laparoscopic splenectomy. Ann Surg 228:35–39

    Article  CAS  PubMed  Google Scholar 

  16. Targarona EM, Espert JJ, Cerdan G, Balague C, Piulachs J, Sugranes G, Artigas V, Trias M (1999) Effect of spleen size on splenectomy outcome: a comparison of open and laparoscopic surgery. Surg Endosc 13:559–562

    Article  CAS  PubMed  Google Scholar 

  17. Kusminsky RE, Boland JP, Tiley EH, Deluca JA (1995) Hand-assisted laparoscopic splenectomy. Surg Laparosc Endosc 5:463–467

    CAS  PubMed  Google Scholar 

  18. Hellman P, Arvidsson D, Rastad J (2000) HandPort-assisted laparoscopic splenectomy in massive splenomegaly. Surg Endosc 14:1177–1179

    Article  CAS  PubMed  Google Scholar 

  19. Rosen M, Brody F, Walsh RM, Ponsky J (2002) Hand-assisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly. Arch Surg 137:1348–1352

    Article  PubMed  Google Scholar 

  20. Borrazzo EC, Daly JM, Morrisey KP, Fischer E, Belmont M, Hogle NJ, Fowler DL (2003) Hand-assisted laparoscopic splenectomy for giant spleens. Surg Endosc 17:918–920

    Article  CAS  PubMed  Google Scholar 

  21. Targarona EM, Balague C, Cerdan G, Espert JJ, Lacy AM, Visa J, Trias M (2002) Hand-assisted laparoscopic splenectomy (HALS) in cases of splenomegaly: a comparison analysis with conventional laparoscopic splenectomy. Surg Endosc 16:426–430

    Article  CAS  PubMed  Google Scholar 

  22. Wang KX, Hu SY, Zhang GY, Chen B, Zhang HF (2007) Hand-assisted laparoscopic splenectomy for splenomegaly: a comparative study with conventional laparoscopic splenectomy. Chin Med J 120:41–45

    PubMed  Google Scholar 

  23. Yano H, Nakano Y, Tono T, Ohnishi T, Iwazawa T, Kimura Y, Kanoh T, Monden T (2004) Hand-assisted laparoscopic splenectomy for splenic tumors. Dig Surg 21:215–222

    Article  PubMed  Google Scholar 

  24. Hiroshi Y, Mitsunobu I, Takushi M, Shigeru O (2003) Hand-assisted laparoscopic splenectomy for splenic vascular tumors: report of two cases. Surg Laparosc Endosc Percutan Tech 4:286–289

    Google Scholar 

  25. Schwenk W, Jacobi C, Mansmann U, Bohm B, Muller JM (2000) Inflammatory response after laparoscopic and conventional colorectal resections results of a prospective randomized trial. Langenbecks Arch Surg 385:2–9

    Article  CAS  PubMed  Google Scholar 

  26. Jacobi CA, Ordemann J, Zieren HU, Volk HD, Bauhofer A, Halle E, Muller JM (1998) Increased systemic inflammation after laparotomy vs laparoscopy in an animal model of peritonitis. Arch Surg 133:258–262

    Article  CAS  PubMed  Google Scholar 

  27. Misawa T, Shiba H, Usuba T, Nojiri T, Kitajima K, Uwagawa T, Toyama Y, Ishida Y, Ishii Y, Yanagisawa A, Kobayashi S, Yanaga K (2007) Systemic inflammatory response syndrome after hand-assisted laparoscopic distal pancreatectomy. Surg Endosc 21:1446–1449

    Article  PubMed  Google Scholar 

  28. 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

    Google Scholar 

  29. Romanelli JR, Kelly JJ, Litwin DE (2001) Hand-assisted laparoscopic surgery in the United States: an overview (review). Semin Laparosc Surg 8:96–103

    Article  CAS  PubMed  Google Scholar 

  30. Litwin DE, Darzi A, Jakimowicz J, Kelly JJ, Arvidsson D, Hansen P, Callery MP, Denis R, Fowler DL, Medich DS, O’Reilly MJ, Atlas H, Himpens JM, Swanstrom LL, Arous EJ, Pattyn P, Yood SM, Ricciardi R, Sandor A, Meyers WC (2000) Hand-assisted laparoscopic surgery (HALS) with the HandPort system: initial experience with 68 patients. Ann Surg 231:715–723

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Umut Barbaros.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barbaros, U., Dinççağ, A., Sümer, A. et al. Prospective randomized comparison of clinical results between hand-assisted laparoscopic and open splenectomies. Surg Endosc 24, 25–32 (2010). https://doi.org/10.1007/s00464-009-0528-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0528-x

Keywords

Navigation