Optimizing the technique of laparoscopic splenectomy in children

Introduction: The first laparoscopic splenectomy in children was managed in 1993 by Tulman. During the past 15 years, laparoscopic splenectomy has become a gold standard in many centres.
Aim: To establish an optimal surgical technique of laparoscopic splenectomy according to our own experience and concerning clinical and economic aspects.
Material and methods: In 1996-2007, 77 laparoscopic splenectomies were carried out in our department. Most of the indications were haematological diseases. Three groups were created from the study population according to the instruments used for preparation and closure of the vessels. Attention was paid to duration of the procedure, complications, conversions, volume of postoperative blood loss, time of analgesic therapy and length of hospital stay.
Results: Mean duration of the procedure was 112 ±53.11 min. Complication rate was 12.98%. There were no statistically significant differences among the three studied groups concerning the number and character of complications. Costs were significantly different in all three groups.
Conclusions:
1. There are no statistically significant differences in the clinical aspects of perioperative course among the three studied groups.
2. The use of disposable instruments and especially LigaSure high energy coagulation essentially lowers overall costs of the procedure.