Retrospective evaluation of anatomical laparoscopic single-port partial splenectomy guided by three-dimensional CT reconstruction planning for hereditary spherocytosis.

OBJECTIVE: The present study compared the efficacy of laparoscopic partial splenectomy (LPS) and laparoscopic total splenectomy (LTS) in treating hereditary spherocytosis, evaluated the safety of anatomy-guided splenectomy using three-dimensional (3D) reconstruction planning, and determined the optimal residual splenic volume threshold.

METHODS: This study included 12 children with hereditary spherocytosis who required single-port laparoscopic splenectomy. Preoperative computed tomography (CT) imaging was used to evaluate the splenic anatomy, vascular topography, and spatial relationships with the pancreas to customize the surgical approach. The operation duration, intraoperative blood loss, and pre/postoperative hematological and immunological parameters were recorded for all patients. The data were statistically analyzed using SPSS (version 26.0). In two cases involving subtotal splenectomy, the residual splenic volume was quantified by 3D reconstruction. Patients were monitored postoperatively for hematological dynamics-particularly platelet counts-and adverse events.

RESULTS: All laparoscopic splenectomies (total/partial) were successfully completed without intraoperative or postoperative complications. Compared with LTS, LPS resulted in a significantly slower trajectory of platelet counts (P < 0.001), whereas postoperative red blood cell (RBC) and hemoglobin levels showed no intergroup differences. Further assessments are needed to determine immunological outcomes. In the two subtotal splenectomy cases, 3D CT reconstruction precisely quantified residual splenic volumes at 3.38 and 6.43% of the preoperative splenic mass postoperatively. Both techniques showed comparable efficacy in terms of resolving anemia and controlling hemolysis. However, compared with LTS, LPS resulted in a slower trajectory for platelet count after surgery. The recovery patterns of RBC counts and hemoglobin levels were comparable between the two approaches.

CONCLUSION: The present study demonstrated that 3D CT reconstruction planning provides a safe and reliable method for laparoscopic splenectomy. The residual splenic volume must be minimized to prevent excessive retention, and preservation of less than 10% of the superior splenic pole is recommended to minimize recurrence risk. The present findings need further validation in multicenter studies with larger sample sizes in the future.