Feasibility and Safety of Laparoscopic Partial Splenectomy: A Systematic Review

摘要

BackgroundLaparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits.MethodsWe conducted a comprehensive review for the years 1995-2018 to retrieve all relevant articles.ResultsA total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50-225min and 0-1200ml, respectively. There are eight patients need blood transfusion in 231 patients with available data. The conversion rate was 3.6% (9/252). Overall, 27 patients (10.7%;27/252) developed postoperative or intraoperative complications. Overall mortality was 0% (0/252). The length of postoperative stay (POS) varied (1-11days). Among four comparative studies, one showed LPS could reduce POS than laparoscopic total splenectomy (LTS) (LTS 5.41.8days, LPS 4.2 +/- 0.8days, p=0.027) and complications (pleural effusion (LTS 9/22, LPS 0/15, p=0.005), splenic vein thrombosis (LTS 10/22, LPS 0/15, p=0.002)). Another comparative study showed LPS may benefit emergency patients. However, one comparative study showed LPS was associated with more pain, longer time to oral intake, and longer POS in children with hereditary spherocytosis. The fourth comparative study showed robotic subtotal splenectomy was comparable to laparoscopy in terms of POS and complication. The main benefits were lower blood loss, vascular dissection time, and a better evaluation of splenic remnant volume.Conclusionsp id=Par4 In early series of highly selected patients, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons.