Single incision laparoscopic splenectomy: feasibility and comparison to multiport laparoscopic splenectomy.

Masataka Ikeda, MD, Mitsugu Sekimoto, MD, Koji Takami, MD, Motohiro Hirao, MD, Michihiko Miyazaki, MD, Hideyasu Ohmiya, MD, Atsushi Miyamoto, MD, Kazuhiro Nishikawa, MD, Tadashi Asaoka, MD, Masakazu Miyake, MD, Kazuyoshi Yamamoto, MD, Naotsugu Haraguchi, MD, Shoji Nakamori, MD. Osaka National Hospital.

Background: We have started single incision laparoscopic splenectomy (SILS) since 2009, and have treated 24 patients (pts). The aim of this study was to compare the clinical outcomes after SILS and conventional multiport laparoscopic splenectomy (LS) to evaluate the feasibility and safety of SILS.

Patients and Methods: Twenty four pts who underwent SILS and 89 pts without splenomegaly who underwent LS were included in this analysis as a control group. Indications for SILS were the same as standard splenectomy except for patients with splenomegay (>500g) and obesity (BMI>30). The operative procedure was identical to LS. Patient demographic data, operative parameters, and postoperative outcomes were assessed.

Results: Indications for SILS were ABO incompatible kidney transplantation (n=16) and idiopathic thrombocytopenic purpura (ITP) (n=5). In the control group, ITP is the most common indication (n=67), and ABO incompatible kidney transplantation was only 6 cases. Thirteen pts (54%) underwent SILS successfully without additional ports. SILS was converted to LS in 2 pts and 1 patient required conversion to an open procedure because of hemorrhage at the splenic hilum. In 8 pts, one additional port was required. Reasons for additional ports were difficulty in hemostasis, tissue dissection, and obtaining clear operative visual field. There was no treatment related death in the both groups. Three and 2 pts had post-operative bleeding at the stump of splenic vessels in the SILS group and the control group, respectively, but they did not require re-operation. In the control group, sub-phrenic fluid collection was detected in one patient. The median operative time, blood loss, and splenic weight were 137.5/120 min, 40/30 ml, and 165/140 g, in the SILS/control group, respectively. SILS is associated with a bit longer operation time and demands operative skills to perform without additional ports. Additional ports allow good visual fields, and easy hemostasis.

Conclusion: SILS is feasible and safe for normal sized spleen in the hands of an experienced laparoscopic surgeon. Additional ports requirement is common and necessary in case of bleeding and bad visual field.

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