Single-Access Transumbilical Laparoscopic Splenectomy Using Curved Reusable Instruments

Giovanni Dapri, MD, Pietro Carnevali, MD, Lorenzo Casali, MD, Jacques Himpens, MD, Guy Bernard Cadiere, MD PhD. European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium

Introduction: The authors report a laparoscopic splenectomy completely performed through a single incision in the umbilicus using direct trocar access and curved reusable instruments.
Video: A 23 years old female consulted for steroid non-responsive therapy idiopathic thrombocytopenic purpura. Preoperative work-up showed a normal sized spleen and thrombocytopenia. The patient showed clinical evidence of steroid therapy side effects Cushing aspects. The umbilicus was incised and a purse-string suture was applied. An 11-mm non disposable trocar was inserted for a 10-mm, 30° angled scope. Curved reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany) were advanced transumbilically. The splenocolic ligament was opened, followed by the opening of the gastrosplenic ligament. Because of the curves of the instruments there was no conflict between the instruments’ tips internally, or between the surgeon’s hands externally. The short gastric vessels were sectioned by curved coagulating hook and curved bipolar scissors. The splenic artery was dissected and isolated from the splenic vein at the level of the splenic hilum. 5-mm straight clip applier was used to ligate the latter vessels. Posterior attachments were freed from hilum to the top and from the hilum to splenic inferior pole. The spleen was retrieved transumbilically in a plastic bag.
Results: Addition of supplementary trocars or incisions was not necessary. Operative time was 180 minutes and final umbilical scar 16 mm. The patient was discharged on 3rd postoperative day; after 3 months she’s doing well.
Conclusions: Single-access laparoscopic splenectomy is feasible and safe to be performed using curved reusable instruments. The curves of the instruments permit surgeon to work in ergonomic position similar to standard laparoscopy, without instruments clushing. The cost of the procedure remains similar to standard laparoscopy.