What we learned from the experience of laparoscopic splenectomy in patients with idiopathic thrombocytopenic purpura (ITP)--single surgeon experiences.

From October 1994 to December 2004, 50 cases of laparoscopic splenectomy (LS) have been carried out by a single surgeon for treating patients with idiopathic thrombocytopenic purpura (ITP). This study was performed to analyze a single surgeon's experiences of LS in ITP and discuss lesions that we have learned and the technical changes based on perioperative outcomes of LS. It seems that strict right lateral decubitus is definitively the position of choice because it ensures good exposure of splenic vascular structure in hilum. We also found that a flexible scope or 45-degree angled telescope, not to mention a 30-degree one, allowed for optimal vision, and made laparoscopic procedures easy and secure. We could control the vascular structure safely by just applying 5-mm laparoscopic clips without using harmonic scalpel or endo-GIA. When delivering spleen, it maybe easy and safe way to remove the plastic pouch with spleen fragmented through the umbilical port after changing the patient's position to supine again.