Masataka Ikeda, MD, Takuya Hamakawa, MD, Sakae Maeda, MD, Mamoru Uemura, MD, Masakazu Miyake, MD, Naoki Hama, Kazuhiro Nishikawa, Atsushi Miyamoto, MD, Michihiko Miyazaki, MD, Motohiro Hirao, MD, Shoji Nakamori, MD, Mitsugu Sekimoto, MD. Osaka National Hospital
Backgrounds: Laparoscopic splenectomy is now a standard choice of treatment for patients for splenectomy. Recent developments of surgical technique and instruments enabled us to perform splenectomy through a single umbilical incision for the purpose of less invasiveness and better cosmetic outcome. The purpose of this study was to evaluate the feasibility and predict the difficulty of single incision laparoscopic splenectomy (SILS) by comparison of conventional multiport laparoscopic splenectomy (MPLS).
Patients and methods: Forty-six patients between November 2009 and June 2016 were included, 18 had ABO incompatible kidney transplantation, 12 had ITP, 6 had splenic tumors, 4 had splenic malignant lymphoma, 3 had splenomegaly and hypersplenism, 2 had splenic artery aneurysm, and one had hereditary spherocytosis. Operative factors and post-operative complications in the two groups were compared.
Results: The male/female ratio was 9/19 in the SILS group, and 9/9 in the MPLS group. The median age was 44 in the SILS group and 50.5 in the MPLS group. The median body mass index (BMI) was significantly smaller in the SILS group (21.3 vs 24.4 kg/m2). The median operative time and estimated blood loss were similar between the two groups, 133.5 min and 30 ml in the SILS group and 120 min and 10 ml in the MPLS group, respectively. The median weight of resected spleen was similar (205g in the SILS group and 255g in the MPLS group). There were no mortalities in all 46 patients. In the MPLS group, there were 4 patients with portal or splenic vein thrombosis (PSVT) detected by routine postoperative CT scan. In the SILS group, we found 4 patients with PSVT, 3 with postoperative bleeding, and only one of 3 patients required transfusion. There were 1 conversion to hand assisted laparoscopic surgery in the MPLS group, and 1 conversion to open surgery in the SILS group due to bleeding. Additional ports were required in 8 patients in the SILS group because of bleeding in 2 and insufficient view for safe operation in 6. Height, body weight, BMI, and spleen weight were similar between patients with and without additional ports. Operative time and blood loss were significantly greater in patients with additional ports (172 min vs 119 min, 190 ml vs 10 ml).
Conclusions: In selected patients, SILS is safe and feasible. We should not hesitate to place additional port for safe operation, as operational difficulty could not be predicted preoperatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78785
Program Number: P603
Presentation Session: Poster (Non CME)
Presentation Type: Poster