A novel three-block method for laparoscopic partial splenectomy: improved spleen preservation and reduced complications.
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PURPOSE: Historically, laparoscopic partial splenectomy has been associated with high rates of conversion to open surgery due to technical challenges. This emphasizes the need for surgical options that allow benign splenic lesion removal with splenic function preservation. Previous approaches primarily blocked the splenic artery, with inadequate intraoperative bleeding control. We aimed to evaluate postoperative clinical recovery and prognostic outcomes of patients who underwent modified three-block laparoscopic partial splenectomy. METHODS: This retrospective study assessed 18 patients with benign splenic lesions who underwent modified three-block laparoscopic partial splenectomy between April 2019 and February 2024. Patient eligibility was determined using predefined criteria; those with malignant lesions or severe comorbidities were excluded. The same laparoscopic hepatobiliary specialist performed all procedures using both splenic artery and pedicle occlusion techniques to minimize intraoperative blood loss. RESULTS: The cohort included 7 men and 11 women, with no conversions to open surgery. The mean operation time was 167.33 ± 59.08 min. The intraoperative blood loss was 50.00 [50.00, 100.00] mL, with no blood transfusion. All patients ambulated within 24 h post-surgery, with a mean hospital stay of 6.5 ± 1.76 days. Only one patient experienced transient pleural effusion classified as a Child-Pugh grade I complication. Follow-up evaluations demonstrated successful tissue preservation, with no overwhelming postsplenectomy infection. CONCLUSIONS: Modified three-block laparoscopic partial splenectomy is a safe and effective approach for managing benign splenic lesions with preservation of splenic function. This technique not only reduces intraoperative bleeding but also facilitates rapid postoperative recovery, thereby mitigating the risks associated with total splenectomy.