2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
234 http://www.sages.org/
Adrenalectomies were transperitoneal and were performed
using sequential, full lateral decubitus positioning.
RESULTS: Both patients were 61 year old females. Operative
times including repositioning were 240 and 245 minutes. Right
lobe wedge liver biopsy was added in one case. Estimated
blood losses were minimal and the operations were uncomplicated.
Regular diets were resumed on the first postoperative
day. Hospital stays were three days, mainly for intravenous
steroids. Pathology confirmed diffuse cortical hyperplasia.
Both patients noted rapid improvement in their Cushing?s syndromes,
including fatigue, emotional lability, supraclavicular
fat, and hyperglycemia. Both are maintained on hydrocortisone
and fludrocortisone, carry injectable dexamethasone and
wear medical alert bracelets. Neither has experienced an
Addisonian crisis at 12 and 2 months follow-up.
CONCLUSIONS: Bilateral total adrenalectomy for ectopic
ACTH-dependent Cushing?s syndrome can be performed
laparoscopically with minimal morbidity, is followed by rapid
clinical improvement, and is a viable alternative to medical
management.
P410–Solid Organ Removal
SURGICAL AUDIT OF FIRST 48 LAPAROSCOPIC SPLENEC-
TOMIES,, Mohammad m Talebpour PhD, godrat m toogeh
PhD,ali m yagoobi PhD, Department of Surgery, Sina Hospital,
Tehran, Iran
Aim: To assess the safety and clinical outcome of laparoscopic
splenectomy.
Method: All consecutive patients referred for laparoscopic
splenectomy to a tertiary centre were included in the audit.
Open splenectomy was carried out on those with huge spleen.
Patients were positioned at 60 degrees semi-supine.
Exploration of upper abdomen was carried out routinely for
presence of accessory spleen. Homeostasis of vessels performed
by intracorporeal suturing routinely and in some conditions
by clips. Spleen put in a bag after emptying of its blood
by cutting hilar vein and removed from bag by splitting.
Results: During 30 months 48 laparoscopic splenectomies
were performed; 39 ITP, 3 spherocytosis with gallstone and 6
moderate splenomegaly with hypersplenism. Mean splenic
size was 9.5*4.5*3.5cm , with the biggest spleen measured at
30 x 12 x 9 cm. Splenic vessels were tied using intra-corporeal
suturing (41 cases) or clips (7 cases). There was one case of
conversion to open surgery. Four cases of ITP did not respond
ideally to splenectomy. In cases of moderate splenomegaly,
spleen was divided into 3 parts prior to use of bag. Mean operative
time was 56 min; and mean length of hospital stay was
2.9 days. All patients discharged from hospital without any
morbidity or mortality.
Conclusion: Laparoscopic splenectomy including moderate
splenomegaly is safe, with good patient outcome.
P411–Solid Organ Removal
EARLY IN-HOSPITAL SPLENECTOMY MAY IMPROVE OUT-
COMES IN IDIOPATHIC THROMBOCYTOPENIA PURPURA (ITP).
D. Tseng MD, T. Deloughery MD, B. Sheppard MD, J. Hunter
MDOregon Health and Sciences University
Objective: For patients who require hospital admission for
exacerbation of ITP, early splenectomy is effective in providing
long lasting remission.
Methods: A retrospective review of patients charts between
1994-2004 at a single tertiary referral center was performed,
identifying 32 patients who underwent splenectomy for ITP.
Results: Long lasting medication free remission was accomplished
in 87% of splenectomized patients up to 9 years.
Incidence of minor complications was 10% with no major complications
or death. In our subset analysis, there were 16
patients who required hospitalization for ITP exacerbation
prior to splenectomy at which time 5 had immediate in-hospital
splenectomy, whereas the other 11 returned for later
splenectomy. Of the 11 who returned for a separate admission,
3 had no platelet improvement after splenectomy, and 3 had
delayed platelet improvement. However, the 5 patients with
immediate in-hospital splenectomy all went on to have expected
platelet response and be medication free.
Conclusions: Immediate in-hospital splenectomy is a reasonable
alternative to chronic steroid use and may be associated
with a higher chance of success compared to later splenectomy.
P412–Solid Organ Removal
HAND-ASSISTED LAPAROSCOPIC SPLENECTOMY FOR A
HUGE SPLENIC CYST: TECHNIQUE AND CASE REPORT.,
Hiroshi Yano MD, Takushi Monden MD,Shigeru Okamoto MD,
Department of Surgery and Pathology, NTT West Osaka
Hospital
Splenic cyst is a relatively rare disease, and most cases are
classified as epidermoid cysts. Splenectomy is generally indicated
for the treatment of a huge splenic cyst to prevent possible
enlargement, rupture, and infection. We report the case of
a huge splenic cyst that was successfully treated by handassisted
laparoscopic splenectomy (HALS). A 17-year-old girl
with a chief complaint of left-sided abdominal pain was admitted
to our department for investigation of a splenic tumor.
Ultrasonography, computed tomography, and magnetic resonance
imaging revealed a huge cystic lesion in the spleen
measuring approximately 10 cm in diameter. HALS was safely
performed to diagnose and treat the splenic tumor. First, a
mini-laparotomy was performed with a 7-cm skin incision in
the mid upper abdomen. A Lapdisc device was inserted
through the mini-laparotomy wound to prevent the leakage of
carbon dioxide gas. Pneumoperitoneum was maintained at a
pressure of 10 mm Hg during the surgery. The cyst was percutaneously
decompressed via a drainage catheter inserted into
the midportion of the cyst. The spleen was mobilized from its
peritoneal attachments with the surgeon?s left hand and
laparoscopic instruments. The hilar vessels were managed
with a vascular stapler. The specimen was delivered out of the
abdominal cavity through the 7-cm skin incision using a vinyl
bag. The intraoperative and postoperative course was
uneventful. The duration of surgery was 100 minutes, and
intraoperative blood loss was insignificant. The histologic
diagnosis was an epithelial cyst of the spleen with no atypical
cells in the cyst wall. The patient was discharged on the fourth
postoperative day in excellent condition. HALS may be a good
method of managing a huge splenic cyst that becomes symptomatic
and potentially life-threatening through enlargement,
rupture, and secondary infection.
P413–Solid Organ Removal
LAPAROSCOPIC TRANSPERITONEAL ADRENALECTOMY
USING LIGASURE, Nihat Yavuz MD, Istanbul
University,Cerrahpasa Medical School,General Surgery
Department
Introduction:
Laparoscopic adrenalectomy is being performed with increasing
frequency in the surgical treatment of adrenal tumors.
Among many laparoscopic approaches to adrenal glands, the
transperitoneal access is the most preferred. Along with the
advancement in technology, the use of different energy systems
has been taken into consideration. The realization of
laparoscopic adrenalectomy has become easier with the use of
LigaSure vessel sealing system(LVSS) which is one of these
energy systems.
Methods:
Between January 2002 and August 2004,23 laparoscopic
transperitoneal adrenalectomies were performed in 22 patients
with the use of LigaSure vessel sealing system. 16 of the
patients were female, 6 were male and the mean age was 44
(range between 17-70). Indications for surgery were non-functioning
adenoma (n=10), pheochromocytoma (n=4), Cushing?s
syndrome (n=5), Conn?s syndrome (n=2) and lymphoma (n=1).
The mean diameter of lesions was 4cm (range between 1-7).12
left,9 right and 1 bilateral adrenalectomies were undertaken.
Results:
The mean operation period was 57 minutes (range between
30-75). The operation period for the patient with Cushing?s
disease in whom bilateral adrenalectomy was performed was
180 minutes. All operatios were completed laparoscopically .A
nonsteroidal antiinflammatory drug (Lornoxicam) has been
sufficient for postoperative analgesia.Oral feeding was started
at the 6th postoperative hour . When used,drains were
removed at the first postoperative day.Postoperative hospital