Laparoscopic splenectomy: preliminary experience.

The role of conventional open splenectomy in the treatment of idiopathic thrombocytopenic purpura (ITP) is well known. As improvement in laparoscopic instruments and techniques have been made, laparoscopic surgery has been significantly extended to include more general surgical procedures. From July 1993 to March 1995, five patients with refractory ITP were treated by laparoscopic splenectomy at National Taiwan University Hospital. The entire procedure was completed under laparoscopic guidance in which four ports were used in four of the five cases. The operative time for these four patients ranged from 180 to 330 minutes with an average time of 225 minutes. The estimated blood loss ranged from 100 to 400 mL with an average of 175 mL. No intraoperative blood transfusions were required. A Penrose drain was in place for 2 to 3 days. All of the patients were able to tolerate a regular diet within 1 postoperative day. The average postoperative hospital stay was 5.25 days. No complications occurred. The remaining laparoscopic surgery was unsuccessful, requiring conversion due to severe bleeding. In conclusion, laparoscopic splenectomy is a feasible and safe procedure for patients with ITP. It may be an alternative choice for a variety of hematologic and pathologic conditions involving the spleen.