HAND-ASSISTED
LAPAROSCOPIC SURGERY (HALS) FOR THE MANAGEMENT OF SPLENOMEGALY
Liu K W 1, Kwok S2, Yeung C
K1
1 Prince of Wales Hospital, Hong Kong, China
2.United Christian Hospital, Hong Kong, China
Objective: Laparoscopic splenectmony is accepted
as an alternative to the open procedure. However, for the management of the large spleen, there
are often inherent problems including longer operating time, difficult
intraoperative dissection and extraction of the specimen. Herein, we report our experience
with 2 cases of HALS for the management of large spleen.
Methods: Two adolescents with hereditary
spherocytosis and ¦Á -thalassemia underevent elective HALS for splenomegaly
(spleen weighing more than 1000gm).
Both had been vaccinated against pneumococcal and meningococcal
infections. The patients were placed in a semi-lateral right decubitus
position. The camera port was in an infra-umbilical position. A 6.5 cm incision was made in the
upper midline for the hand-port and a 12mm trochar was inserted in the left
iliac fossa for the use of the ultrasonic scalpel and the linear
stapler.
Results: The mean operating time was 144 minutes
and the mean hospital stay was 5 days. No blood transfusion was
required. Post-operative
recovery was uneventful.
Conclusion: The laparoscopic approach is now
accepted as an alternative approach to perform splenectomies. HALS can
provide an additional surgical armamentarium in the management of large
spleen. It has the following added advantages over the conventional laparoscopic
approach: shorter operating
time, easier dissection and extraction of the specimen.