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. 2020 Mar 18;36(1):72-81.
doi: 10.5578/turkjsurg.4535. eCollection 2020 Mar.

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

Mehmet Aziret  1 , Bülent Koyun  1 , Kerem Karaman  1 , Cenk Sunu  2 , Alper Karacan  3 , Volkan Öter  1 , Fehmi Çelebi  1 , Metin Ercan  1 , Erdal Birol Bostancı  1
Affiliations

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

Mehmet Aziret et al. Turk J Surg. .

Abstract

Objectives: Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum dissection technique.

Material and methods: A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8). Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity.

Results: No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease, operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p <0.05) were higher in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to open surgery.

Conclusion: Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.

Keywords: Conversion to open surgery; indirect hilum dissection; laparoscopic splenectomy; robotic splenectomy.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Flowchart of the study
Figure 2
Figure 2. Robotic splenectomy during splenic hilum dissection.
Figure 3
Figure 3. Port placements for laparoscopic splenectomy
Figure 4
Figure 4. Indirect splenic hilum dissection; removing of the spleno-colonic and spleno-diapragmatic liga- ments (A), and splenic vascular plane after bilateral hilum dissection (arrow: splenic pedicle) (B).
See this image and copyright information in PMC

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