HAND-ASSISTED LAPAROSCOPIC SPLENECTOMY (HALS)

First described in 1991 by Delaitre and his colleagues, laparoscopic splenectomy has become a common mode of treatment of various disorders including ITP, hematologic malignancy and hereditary spherocytosis.Laparoscopic splenectomy presents an advantage over open splenectomy resulting in shorter hospital stay, decreased blood loss and few operative and postoperative complications.Splenomegaly has long been a contraindication to laparoscopy as it presents the challenge of limited retraction and hilar visualization. In addition, splenomegaly leads to an increased risk of bleeding, capsular disruption and conversion to open splenectomy .A hand-assisted laparoscopic splenectomy (HALS) allows the removal of larger spleens without conversion to open splenectomy as it provides the surgeon with the ability to maintain tactile sensation and to better manipulate the organ.Using hand-assisted laparoscopy for the removal of giant spleens may actually reduce intra-operative complications, decrease operative times and shorten overall hospital stay when compared with standard laparoscopy.Laparoscopic splenectomy (LS) in patients with significant splenomegaly or prior upper abdominal operation is technically challenging with a high conversion rate to open operation. It is hypothesized that hand-assisted laparoscopic splenectomy in this setting would improve operative outcomes without impacting post-operative ileus, length of stay, morbidity or mortality compared with LS.The use of harmonic scalpel & legasure in laparoscopic splenectomy are safe and effective as it improves haemostasis, facilitates dissection, decreases operative time, shortens hospitalization and hence improves long term results.