Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy
Mehmet Aziret1, Bülent Koyun1, Kerem Karaman1, Cenk Sunu2, Alper Karacan3, Volkan Öter1, Fehmi Çelebi1, Metin Ercan1, Erdal Birol Bostancı1
1Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
2Clinic of Hematology, Sakarya University Training and Research Hospital, Sakarya, Turkey
3Clinic of Radiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
4Clinic of General Surgery, Health Science University Ankara City Hospital, Ankara, Turkey
Objective: 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
Cite this article as: Aziret M, Koyun B, Karaman K, Sunu C, Karacan A, Öter V, et al. Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy. Turk J Surg 2020; 36 (1): 72-81.
The Ethical Committee of the Sakarya University Education and Research Hospital approved the study protocol (71522473/050.01.04/2).
Not required in this study.
Concept - M.A., K.K.; Design - M.E.; Supervision - F.Ç.; Data Collection and/or Processing - C.S., A.K.; Analysis and Interpretation - M.A., B.K.; Literature Search - V.Ö.; Writing Manuscript - M.A., E.B.B.; Critical Reviews - E.B.B
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.