Prospective Randomized Study Between Open and Hand Assisted Splenectomies

The advent of laparoscopic surgery, increasing experience in its performance and advances in techniques and surgical devices have all greatly influenced general surgery. The usefulness of laparoscopic surgery has already been well proven in cholecystectomy, esophageal antireflux surgery, and splenectomy for benign diseases (1). Laparoscopy is also now gaining recognition for procedures accompanied by lymph node dissection, such as gastric and colorectal surgery (2, 3). The development of hand-assisted laparoscopic surgery (HALS) has also brought about improvements in regard to various disadvantages that have previously been associated with laparoscopic surgery, including lack of tactile sensation feedback, poor depth perception, lack of quick access in the event of unexpected hemorrhage, and difficulties with intracorporal suturing. Such improvements have enabled the performance of advanced laparoscopic surgery (4).

To solve the problems associated with a long learning curve and long operating times, hand ports have been introduced. Through the hand port, the surgeon's hand can be introduced into the abdomen while the pneumoperitoneum is preserved. The use of a hand port reduces operating time and shortens the learning curve (5). It has already been suggested that procedures requiring an incision to remove a specimen or organ are most suitable for HALS (6).

Laparoscopic splenectomy (LS) for the normal-sized spleen has been shown to be a safe procedure, resulting in short hospital stays, low postoperative pain scores, technical hurdles and, as a result, can be more difficult. LS has advantages over open splenectomy (7), and it is now considered by many surgeons to be the procedure of choice for normal-sized spleens. Splenectomy for giant spleens using solely laparoscopic approaches is feasible, but it can be time consuming and challenging to any surgeon despite his or her high level of experience with laparoscopy.

With increased splenic sizes, LS becomes more technically challenging, although the procedure is still feasible (8,5). Hand-assisted laparoscopic technique allows the surgeon to place one hand into the abdominal cavity while maintaining the pneumoperitoneum, recovering tactile sense and improving the accuracy of manipulation. This has been verified in various complicated laparoscopic procedures, including colectomies, nephrectomies, and hepatectomies. Based on these experiences, HALS may be well suited for the removal of splenomegaly when the final spleen weight is greater than 500 g (9).

It would be of interest to assess whether outcomes of the HALS hybrid technique approximate those obtained with laparoscopy or with the open approach. Since comparative studies between laparoscopy and HALS have been already carried out, we compared open splenectomy with HALS for splenomegaly cases. To our knowledge, this is the first prospective study to compare the results of HALS and OS.