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Technical developments and a team approach leads to an improved outcome: lessons learnt implementing laparoscopic splenectomy.

Sorway W Chan·Chris Hensman·Bruce P Waxman·Stephen Blamey·John Cox·Ken Farrell·Jane Fox·John Gribbin·Laront Layani
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Abstract

BACKGROUND: To document the technical aspects, outcome and lessons learnt during the learning curve phase of implementing laparoscopic splenectomy, by comparing the results before and after the introduction of a standardized technique. METHODS: We present a retrospective and prospective review of laparoscopic splenectomies over a 4-year period. Two chronological periods were studied, before and after the implementation of a standardized technique of a laparoscopic splenectomy involving: (i) hilar dissection with ultrasonic shears; (ii) two experienced laparoscopic surgeons; and (iii) trained dedicated equipment and staff using a checklist approach in the preparation and conduct of the operation. Two groups of patients were studied relating to the periods before and after the implementation of a standardized technique. Statistical methods used were the Wilcoxon's rank sum test and the two-sample test. RESULTS: Thirty-one laparoscopic splenectomies were attempted. The most common indication was for idiopathic thrombocytopenic purpura. When comparing the early phase (n = 15) with the standardized technique phase (n = 16), there was a significant reduction in conversion rates (40% vs 6%), operating times (218 min vs 171 min), complication rates (6 cases including 1 death vs none) and length of stay (11 days vs 4 days). The results were significant for reduction in hospital stay, conversion rates and complications rates. CONCLUSIONS: A reduction in conversion rates, operating time, morbidity and length of stay was realized during the learning curve of implementing laparoscopic splenectomy by adopting a standardized technique. This technique involved hilar dissection using the ultrasonic shears, two experienced laparoscopic surgeons performing the surgery, dedicated equipment and trained staff using the checklist approach. We recommend such a standardized technique in performing laparoscopic splenectomy.

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AdultAgedAged, 80 and overFemaleHumansLaparoscopyMaleMiddle AgedMinimally Invasive Surgical ProceduresPatient Care TeamProspective StudiesRetrospective StudiesSplenectomyTreatment OutcomeComparative StudyJournal Article

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Sorway W Chan, Chris Hensman, Bruce P Waxman, Stephen Blamey, John Cox, Ken Farrell, Jane Fox, John Gribbin, Laront Layani. 2002. Technical developments and a team approach leads to an improved outcome: lessons learnt implementing laparoscopic splenectomy.. https://doi.org/10.1046/j.1445-2197.2002.02461.x

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