Surgical strategy and controversy about upper limit of splenic size for laparoscopic splenectomy

Laparoscopic splenectomy (LS) is consi dered as the standard approach for patients with normal-sized or moderately enlarged spleens because of advantages of minimal invasion. With the improvement of laparoscopic techniques, the previous concept that massive splenomegaly (MS) is a contraindication to LS is being challenged. Nevertheless, there is still a tremendous controversy over this issue. (1) Splenomegaly and MS are not clearly defined. (2) The feasibility, safety and postoperative outcomes of LS for MS are fiercely debated despite much improvement of LS for MS. (3) Whether supporting or opposing LS for MS, the core problem that the upper limit of splenic size can be in accord with a requirement of LS is controversial. Taking these issues into account, authors recommended that the splenomegaly should be divided into “four degrees”  rather than “three degrees” for the sake of guiding the choice of surgery.