Reappraisal of anterior approach to laparoscopic splenectomy: technical feasibility and its clinical application.

Laparoscopic splenectomy has been accepted as the treatment of choice in managing spleen-associated pathologic conditions requiring splenectomy. We introduce our surgical technique of modified laparoscopic splenectomy and discuss its technical feasibility and safety. From March 2006 to March 2010, 38 patients underwent modified laparoscopic splenectomy. Mean operating time was 169.5 ± 109.6 minutes. Mean blood loss was 468 ± 971.5 mL. Intraoperative transfusions were given to 10 patients (25.6%). There was no case for open conversion. In learning curve analysis, outcomes significantly improved with the first 17 patients. When we compared first 27 cases of conventional laparoscopic splenectomy with recent cases of modified technique, the 2 groups showed no significant difference. The presented technique of modified laparoscopic splenectomy seems to be a feasible, easy, and safe procedure. It is also thought that surgical indication could be extended even to the splenomegaly by this technique.