Masanobu Hagiike, MD PhD, Seiji Noge, MD, Hiroto Yamada, MD, Takuo Noda, MD, Takanori Oyama, MD, Hiroyuki Kubo, MD, Norikatsu Maeda, MD, Hirotaka Kashiwagi, MD, Masao Fujiwara, MD, Yasuyuki Suzuki, MD. Department of Gastroenterological and Pediatric Surgery, Kagawa University, Japan
Pediatric laparoscopic treatment is now widespread because of its feasibility and patient’s quick recovery from operation. We performed concomitant splenectomy and cholecystectomy in a 13-year old girl with hereditary spherocytosis and cholelithiasis. Patient was operated on using right semi lateral position, tilting the table from right to left, with four-trocar technique. Splenectomy was performed first, and then cholecystectomy was achieved. First trocar was inserted from umbilical area. Two 5mm trocars were inserted at upper midline area and left lower abdominal area. After adhesiolysis between spleen and colon, 10mm trocar was inserted at mid left lower area for stapling device. Operator was using upper midline trocar and left mid trocar, and assistant using left lateral trocar. Scope was inserted from umbilical trocar. Spleen was dissected by using LCS and electric coagulator. Tilting bed was very useful for these two procedures. While dissecting lateral side of spleen, right lateral position made good visualization and while dissecting gastro-splenic ligament, near supine position was useful. Using gravity was very important during operation. Dissection between pancreas tail and spleen could be safely possible by LCS. Hilar section was performed by tri-stapler (New Endo GIA: three line stapling device which height are all different and invented for solid organ). We use plastic bag to remove spleen. Then Laparoscopic cholecystectomy was performed under supine head-up position. We use same trocar and did not add any trocar for this procedure. We used right lower semi lateral trocar for scope, midline upper trocar for right hand and umbilical one for left hand of operator. Inflammation of cholecystitis was not so severe and dissection was easy. Gall bladder was also collected by plastic bag. We put drain at the left sub phrenic area and close abdominal wall. Bleeding is 28ml and operating time for both procedures was 256 min. Patient recovered rapidly and returned to unrestricted activity quickly. Laboratory data showed getting better value of Jaundice and anemia in a few days.
Laparoscopic splenectomy and cholecystectomy is feasible and best procedure for hereditary spherocytosis child. The appropriate positioning of each laparoscopic trocar is essential for a good operative view and smooth access. Using gravity is also very effective and important. We report this case with discussions of reported papers.
Session Number: Poster – Poster Presentations
Program Number: P601