The learning curve associated with pediatric laparoscopic splenectomy

Background: Laparoscopic splenectomy (LS) is technically difficult compared with open splenectomy. This report examines our experience with LS to define the learning curve. Methods: The first 49 consecutive laparoscopic splenectomies were reviewed. Indications, complications, operative time, and costs were recorded. Results: Indications included hereditary spherocytosis, immune thrombocytopenia purpura, beta-thalassemia, lymphoma, splenic cysts, and abscesses. Surgical time averaged 196 minutes for the first 10 patients, decreasing to 105 minutes for the last 10. Blood loss for the first 10 patients averaged 50 cc and less than 5 cc for the last 10. There were 3 complications and 1 conversion to open operation. Operative and hospital charges averaged $6,670 and $13,402, respectively, for the first 10 cases compared with $5,278 and $10,863 for the last 10. Conclusions: LS can be performed safely with few complications. LS has a steep learning curve in the first 20 patients after which operative times decrease along with overall costs.