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Invited Critique
January 1, 2004

Predictive Factors for Successful Laparoscopic Splenectomy in Patients With Immune Thrombocytopenic Purpura—Invited Critique

Arch Surg. 2004;139(1):66. doi:10.1001/archsurg.139.1.66

There has been a slow but steady change in attitude toward the application of minimally invasive surgery in the treatment of certain infrequent diseases for which surgery used to be considered an excessively aggressive alternative to medical or less invasive approaches. This change has had a great effect on the treatment policy for diseases such as achalasia, gastroesophageal reflux, and ITP. Once the feasibility and safety of the minimally invasive surgical alternative was demonstrated, the new-approach old-procedure surgery reclaimed its place as first-line therapy. This has been the case with LS for ITP, as recent reports demonstrate.1-5 Another advantage of LS is a "revisiting effect"; many of the surgical aspects of these diseases have been reanalyzed. For example, when the surgical approach is proposed as first-line treatment, it is investigated for its ability to replace the open approach on a long-term basis. Another aspect is how to select or predict the outcome of LS, especially in the context of a disease in which there are many dark areas and in which the result is still not entirely predictable.