2005 SAGES Abstracts

POSTER ABSTRACTS
P406–Solid Organ Removal
LAPAROSCOPIC SPLENECTOMY FOR DELAYED SPLENIC RUP-
TURE FOLLOWING EMBOLIZATION, Edward A Pucci MD,
Harry Zemon MD,Todd Ponsky MD,Fred Brody MD,
Department of Surgery, The George Washington University
Medical Center, Washington, DC
Over the last several years, nonoperative management has
become the standard of care for hemodynamically stable
patients with splenic trauma. Successful nonoperative management
is secondary to advances in intensive care monitoring,
splenic embolization and radiologic techniques. When
nonoperative management and embolization fail, surgery is
required. A laparoscopic approach has been utilized in only a
few cases. Furthermore, only one case of a totally laparoscopic
splenectomy (LS) has been reported following splenic rupture.
We report the first case of a totally laparoscopic splenectomy
for a delayed splenic rupture following embolization.
A 32-year-old male bicyclist was admitted to the hospital after
a bus struck him. On presentation, he was hemodynamically
stable with a GCS of 15 and no loss of consciousness. A CT
scan of the abdomen and pelvis showed a significant hemoperitoneum
with a splenic rupture. Celiac angiography
revealed extravasation of contrast from a terminal segmental
branch from the lower pole of the spleen. Three titanium coils
were placed in order to embolize a splenic artery pseudoaneurysm.
The patient remained stable until post procedure day
4 when he developed acute right lower quadrant pain with
abdominal distension. Concurrently, his systolic blood pressure
fell to 84 mmHg. He was then taken to the operating
room emergently for a diagnostic laparoscopy and LS.
At surgery, 1.5 liters of blood was evacuated and a large laceration
was apparent across the body of the spleen. A gauze pad
was inserted and used to tamponade the laceration while the
splenectomy was performed. The avascular attachments and
short gastric vessels were divided with the ultrasonic scalpel
and the hilum was divided with endovascular staplers.
Ultimately, he was discharged to home on post operative day
six without complications. At three weeks after his surgery, he
returned to work and his normal activities.
This is the first case report of a LS for a ruptured spleen following
embolization. Currently, the role of diagnostic and therapeutic
laparoscopy has increased over the last decade for
blunt and penetrating trauma. At this time, the exact role of LS
for trauma is unclear. As the indications for laparoscopy
expand with trauma, LS should be considered for splenic rupture.
Surgical expertise and patient selection are crucial for a
successful LS.
P407–Solid Organ Removal
LAPAROSCOPIC VS. OPEN DONOR NEPHRECTOMY: COMPAR-
ISON OF DONOR AND RECEPIENT OUTCOMES, Eugene
Rubach MD, Andrew Isenberg MD,T. Paul Singh MD,David
Conti MD, Albany Medical Center, North Shore - Long Island
Jewish Healthcare System
**Objective** Renal transplantation is the only available cure
for end-stage renal disease. To alleviate the need for cadaveric
organs, live donation was developed. Laparoscopic donor
nephrectomy was introduced to minimize postoperative donor
morbidity while providing results equivalent to open operations.
This study is a review of our institution’s initial experience
with laparoscopic donor nephrectomy. This is a case-control
study comparing laparoscopic donors with matched open
controls. There are 2 arms to the study: donor outcomes and
recipient outcomes.
**Study design** 11 donors underwent laparoscopic nephrectomy
in 1999-2002. They were compared to 11 matched
donors who underwent open nephrectomy during the same
time period. Recipients of all 22 kidneys were followed for 18-
60 months. 2-tailed t-test with Bonferroni correction and
repeated measures ANOVA were used for data analysis.
**Donor outcomes** Open and laparoscopic donors were
similar in terms of age, sex, number of arteries and veins, preoperative
and postoperative hematocrit and estimated blood
loss. However, laparoscopic donors had longer operating
room time (368 vs. 256 min, p