eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
Current issue Archive Videoforum Manuscripts accepted About the journal Supplements Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank

vol. 13
Original paper

Quest for the optimal technique of laparoscopic splenectomy – vessels first or hilar transection?

Dorota Radkowiak, Anna Zychowicz, Michał Wysocki, Anna Lasek, Piotr Major, Michał Pędziwiatr, Piotr Budzyński, Marcin Dembiński, Jadwiga Dworak, Andrzej Budzynski

Videosurgery Miniinv 2018; 13 (4): 460–468
Online publish date: 2018/05/30
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Throughout our 20 years of experience, we have used several different techniques for laparoscopic splenectomy (LS). However, two methods have been used most frequently: “vessels first” and “hilar transection”.

To evaluate the outcomes of LS performed with these two different approaches.

Material and methods
It was an observational study based on retrospective analysis of consecutive patients undergoing LS in a tertiary referral surgical center in the period 1998–2017. We excluded patients with splenic trauma, initially submitted to open surgery, stapled transection of splenic hilum, partial resections of the spleen and other spleen-preserving procedures. Patients were divided into two groups: group 1 (“vessels first”) with 188 patients, and group 2 (“hilar transection”) with 287 patients.

Mean operative time was shorter (p < 0.001) and blood loss was lower (p < 0.001) in group 2. The need for blood transfusions and the conversion rate were higher in group 1 (p = 0.044 and p = 0.003 respectively). There was no difference in intraoperative adverse events (p = 0.179). Overall postoperative morbidity did not differ between groups (p = 0.081) and we noted mortality of 0.21% (1 patient of group 2). The morbidity rate associated with accidental injury of the pancreatic parenchyma was significantly higher in group 1 (p = 0.028). Median length of hospital stay was 4 days (range: 1–99) and did not differ between groups (p = 0.175).

The “vessels first” technique is associated with longer operative time, higher blood loss and increased risk of conversion. “Hilar transection” is associated with lower incidence of local complications related most likely to accidental injury of the pancreatic tail. In the case of a large caliber of splenic vessels the “vessels first” approach remains the technique of choice.


laparoscopy, spleen, splenectomy, vessels first, hilar transection, morbidity, mortality

Dionigi R, Boni L, Rausei S, Rovera F, Dionigi G. History of splenectomy. Int J Surg 2013; 11 (Suppl 1): S42-3.
Carroll BJ, Phillips EH, Semel CJ, et al. Laparoscopic splenectomy. Surg Endosc 1992; 6: 183-5.
Delaitre B, Maignien B. Laparoscopic splenectomy: technical aspects. Surg Endosc 1992; 6: 305-8.
Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med 1991; 20: 2263.
Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care 2004; 8: 373-81.
Kathariya R, Devanoorkar A, Jain H. Intra-operative hemorrhage: a review of literature. Med Diagnostic Methods 2013; 2: 1-5.
Expert team. Polish Guidelines for the Treatment with Blood, Its Components and with Blood Products in Medical Entities. WEMA Wydawnictwo-Poligrafia, Warsaw 2014.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications. Ann Surg 2009; 250: 187-96.
Budzyński A, Matłok M, Pędziwiatr M, et al. SILS (single incision laparoscopic surgery) – new surgical approach to peritoneal cavity. Adv Med Sci 2011; 56: 18-24.
Pędziwiatr M, Matłok M, Major P, et al. Laparoscopic surgery of the spleen through single umbilical incision. Videosurgery Miniinv 2013; 8: 8-12.
Budzyński A, Bobrzyński A, Krzywoń J, et al. Technika “vessel first” w technicznie trudnej splenektomii laparoskopowej. Pol J Surg 2002; 74: 789-96.
Budzynski A, Bobrzynski A, Krzywon J. Laparoscopic surgery of the spleen. Przegl Lek 2001; 58: 158-61.
Motheral B, Brooks J, Clark MA, et al. A checklist for retrospective database studies – report of the ISPOR task force on retrospective databases. Value Heal 2003; 6: 90-7.
Habermalz B, Sauerland S, Decker G, et al. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2008; 22: 821-48.
Corcione F, Pirozzi F, Aragiusto G, et al. Laparoscopic splenectomy: experience of a single center in a series of 300 cases. Surg Endosc Other Interv Tech 2012; 26: 2870-6.
Rosen M, Brody F, Walsh RM, et al. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc Other Interv Tech 2002; 16: 272-9.
Bai YN, Jiang H, Prasoon P. A meta-analysis of perioperative outcomes of laparoscopic splenectomy for hematological disorders. World J Surg 2012; 36: 2349-58.
Moris D, Dimitriou N, Griniatsos J. Laparoscopic splenectomy for benign hematological disorders in adults: a systematic review. In Vivo 2017; 31: 291-302.
Chen J, Ma R, Yang SZ, et al. Perioperative outcomes of laparoscopic versus open splenectomy for nontraumatic diseases: a meta-analysis. Chin Med J (Engl) 2014; 127: 2504-10.
Radkowiak D, Zychowicz A, Lasek A, et al. 20 years’ experience with laparoscopic splenectomy. Single center outcomes of a cohort study of 500 cases. Int J Surg 2018; 52: 285-92.
Zheng D, Huang CS, Huang SB, Zheng CX. Laparoscopic splenectomy for primary immune thrombocytopenia: current status and challenges. World J Gastrointest Endosc 2016; 8: 610-5.
Al-Mulhim AS. Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases. Surg Endosc Other Interv Tech 2012; 26: 3186-9.
Koshenkov VP, Németh ZH, Carter MS. Laparoscopic splenectomy: outcome and efficacy for massive and supramassive spleens. Am J Surg 2012; 203: 517-22.
Heniford BT, Park A, Walsh RM, et al. Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: does size matter? Am Surg 2001; 67: 854-7.
Somasundaram SK, Massey L, Gooch D, et al. Laparoscopic splenectomy is emerging “gold standard” treatment even for massive spleens. Ann R Coll Surg Engl 2015; 97: 345-8.
Chen X, Peng B, Cai Y, et al. Laparoscopic splenectomy for patients with immune thrombocytopenia and very low platelet count: is platelet transfusion necessary? J Surg Res 2011; 170: e225-32.
Wu Z, Zhou J, Li J, et al. The feasibility of laparoscopic splenectomy for ITP patients without preoperative platelet transfusion. Hepatogastroenterology 2012; 59: 81-5.
Feldman LS. Laparoscopic splenectomy: standardized approach. World J Surg 2011; 35: 1487-95.
Fisichella PM, Wong YM, Pappas SG, Abood GJ. Laparoscopic splenectomy: perioperative management, surgical technique, and results. J Gastrointest Surg 2014; 18: 404-10.
Deeb AP, Kim MJ, Fleming FJ, et al. The impact of operative approach in elective splenectomy: a multivariate analysis of outcomes from the NSQIP database. Surg Laparosc Endosc Percutan Tech 2012; 22: 415-9.
Qian D, He Z, Hua J, et al. Hand-assisted versus conventional laparoscopic splenectomy: a systematic review and meta-analysis. ANZ J Surg 2014; 84: 915-20.
Park A, Targarona EM, Trías M. Laparoscopic surgery of the spleen: state of the art. Langenbeck’s Arch Surg 2001; 386: 230-9.
Zhan XL, Ji Y, Wang YD. Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension. World J Gastroenterol 2014; 20: 5794-800.
Entezari K, Hoffmann P, Goris M, et al. A review of currently available vessel sealing systems. Miniim Invasive Ther Allied Technol 2007; 16: 52-7.
Smith R, Pasic R. The role of vessel sealing technologies in laparoscopic surgery. Surg Technol Int 2008; 17: 208-12.
Major P, Matłok M, Pędziwiatr M, Budzyński A. Do we really need routine drainage after laparoscopic adrenalectomy and splenectomy? Videosurgery Miniinv 2012; 7: 33-9.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe