Handport-assisted laparoscopic splenectomy in massive splenomegaly

Background: Laparoscopic splenectomy of normal-sized spleens is performed with increasing frequency. By using a handport, which allows the intraperitoneal introduction of one surgeon's hand, massively enlarged spleens may also be extirpated via a laparopscopy-assisted technique. Methods: Seven patients (54-80 years) with massive splenomegaly (3.5-5.8 kg) underwent handport-assisted laparoscopic splenectomy. Ail patients had spleens that extended beyond the umbilicus, hypersplenism, and discomfort in the upper left quadrant due to intractable hematological malignancy. Results: Both the operation and recovery were uneventful in five of the patients, but one patient had to be converted to an open procedure due to splenic damage and bleeding, and another was reoperated for hemorrhage from a trocar. The handport allowed splenic protection while the trocars were introduced and instruments changed. It also enabled splenic mobilization, particularly prior to stapling of the hilar structures and dissection of the upper splenic pole. Conclusions: Handport-assisted laparoscopic splenectomy seems to be a viable alternative for massive splenomegaly, but it requires further evaluation with respect to safety, efficacy, and indication.