Laparoscopic splenectomy by secondary pedicle division strategy:a highly cost-effective method

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Author:
CAI Xiu-jun(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
SHEN Bo(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
YU Hong(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
LIANG Xiao(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
ZHU Lin-hua(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
WANG Yi-fan(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
DAI Yi(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
YANG Jin(Institute of Micro-Invasive Surgery of Zhejiang University,Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310016,China)
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 121, Issue 02, 2008
DOI:
Key Word:
laparoscopic surgery;splenectomy;spleen

Abstract: Background Laparoscopic splenectomy(LS)shows many advantages compared with open surgery except for the high cost.This study was aimed to recommend secondary pedicle division strategy as a method with high cost-effectiveness.Methods From January 2003 to June 2005,14 consecutive patients underwent laparoscopic splenectomy.The splenic pedicle was controlled by secondary pedicle division strategy in 8 cases and by Endo-GIA in the other 6 cases.A retrospective study was carried out to evaluate the operative time,blood loss,time to diet,operative morbidity,postoperative stay,and operative cost.Results LS was performed successfully in a totaI of 14 cases.There was no significant difference between the two strategies in operative time,blood loss,time to diet,operative morbidity and postoperative stay.The operative cost of secondary pedicle division strategy group(RMB 8354.38±752.10)was significantly lower than that of Endo-GIA group (RMB 11053.33±602.27)(P<0.01).Conclusions Laparoscopic splenectomy by secondary pedicle division strategy is a safe,effective and economical procedure with the value of popularization in developing countries.

  • [1]Delaitre B,Maignien B,Icard P.Laparoscopic splenectomy.Br J Surg 1992;79:1334.
  • [2]Knauer EM,Ailawadi G,Yahanda A,Obermeyer RJ,Millie MP,Ojeda H,et al.101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders.Am J Surg 2003;186:500-504.
  • [3]Tafloue K,Okita K,Akahoshi T'Konishi K,Gotoh N,Tsutsumi N,et al.Laparoscopic splenectomy for hematologic diseases.Surgery 2002;131:S318-S323.
  • [4]Wu JM,Lai IR,Yuan RH,Yu SC.Laparoscopic splenectomy for idiopathic thrombocytopenic purpura.Am J Surg 2004;187:720-723.
  • [5]Katkhouda N,Mayor E.Laparoscopic splenectomy.Surg Clin North Am 2000;80:1285-1297.
  • [6]Pomp A,Gagner M,Salky B,Caraccio A,Nahouraii R,Reiner M,et al.Laparoscopic splenectomy:a selected retrospective review.Surg Laparosc Endosc Percutan Tech 2005;15:139-143.
  • [7]Carbonell AM,Kercher KW,Matthews BD,Joels CS,Sing RF,Heniford BT.Laparoscopic splenectomy for splenic abscess.Surg Laparosc Endosc Percutan Tech 2004;14:289-291.
  • [8]Smith L,Luna G,Merg AR,McNevin MS,Moore MR,Bax TW.Laparoscopic splenectomy for treatment of splenomegaly.Am J Surg 2004;187:618-620.
  • [9]Harold KL,Schlinkert RT,Mann DK,Reeder CB,Noel P,Fitch TR,et al.Long-term results of laparoscopic splenectomy for immune thrombocytopenic purpura.Mayo Clin Proc 1999;74:37-39.
  • [10]Cordera F,Long KH,Nagorney DM,McMurtry EK,Schleck C,Ilstrup D,et al.Open versus laparoscopic splenectomy for idiopathic thrombocytopenic purpura:clinical and economic analysis.Surgery 2003;134:45-52.
  • [11]Park A,Marcaccio M,Sternbach M,Witzke D,Fitzgerald P.Laparoscopic vs open splenectomy.Arch Surg 1999;134:1263-1269.
  • [12]Katkhouda N,Manhas S,Umbach TW,Kaiser AM.Laparoscopic splenectomy.J Laparoendosc Adv Surg Tech A 2001;11:383-390.
  • [13]Winslow ER,Brunt LM.Perioperative outcomes of laparoscopic versus open splenectomy:a meta-analysis with an emphasis on complications.Surgery 2003;134:647-655.
  • [14]Tan M,Zheng CX,Wu ZM,Chen GT,Chen LH,Zhao ZX.Laparoscopic splenectomy:the latest technical evaluation.World J Grastroenterol 2003;9:1086-1089.
  • [15]Hamamci EO,Besim H,Bostanoglu S,Sonisik M,Korkmaz A.Use of laparoscopic splenectomy in developing countries:analysis of cost and strategies for reducing cost.J Laparoendosc Adv Surg Tech A 2002;12:253-258.
  • [16]Wang XF,Cai XJ,Li W,Yu H,Liang X,Cai XY.Outcome and efficacy of laparoscopic splenectomy in treatment of idiopathic thrombocytopenic purpura.Natl Med J Chin(Chin) 2004;84:653-655.
  • [17]Li HQ,Zhang L,Zhao H,Ji LX,Yang RC.Chronic idiopathic thrombocytopenic purpura in adult Chinese patients:a retrospective single-centered analysis of 1791 cases.Chin Med J 2005;118:34-37.
  • [18]Hanly EJ,Mendoza-Sagaon M,Murata K,Hardacre JM,De Maio A.Talamini MA.CO2 Pneumoperitoneum modifies the inflammatory response to sepsis.Ann Surg 2003;237:343-350.
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