Single-incision Laparoscopic Splenectomy; The Technical Refinements

Takeyuki Misawa, MD, PhD, Yuki Fujiwara, MD, PhD, Junichi Shimada, MD, Norimitsu Okui, MD, Hiroaki Kitamura, MD, Nobuhiro Tsutsui, MD, Hiroaki Shiba, MD, Yasuro Futagawa, MD, PhD, Shigeki Wakiyama, MD, Yuichi Ishida, MD, PhD, Katsuhiko Yanaga, MD

Department of Surgery, The Jikei University School of Medicine

Objective: To describe our technical refinements in performing single-incision laparoscopic splenectomy (SILS).

Patients and Methods: Between December 2009 and September 2012, we performed SILS in 16 patients (age, 38±18 years; male, 4; female, 12): 7 with idiopathic thrombocytopenic purpula (ITP), 3 with cystic lesions, 2 each with liver cirrhosis, and splenic aneurysm, 1 each with hereditary spherocytosis, and splenic tumor. The patients were positioned in the right semilateral position with the left arm fixed over the head. A 2.5-cm intraumbilical minilaparotomy was made to place a SILS™Port with three 5-mm trocars as a single access site. Under pneumoperitoneum, a flexible 5-mm laparoscope and an articulating grasper were used in addition to standard laparoscopic equipments. A LigaSure™V vessel sealer was used to dissect all ligaments around the spleen. After splenic hilar dissection, a 3-5mm-wide cloth tape was introduced intraperitoneally to encircle and tug the splenic hilum. Both ends of the tape were trapped and extracted with a laparoscopic suture passer through an extra needle hole in the skin. Retraction of the tape in appropriate directions provided excellent exposure of the splenic hilum, the pancreatic tail, and the splenic artery as well as vein. Following gentle trimming of the splenic hilum under sufficient tension and exposure by tugging the spleen, a linear stapler was introduced for stapling and dividing the splenic hilum including the splenic artery and vein. To avoid hilar and splenic injury by the tip of stapler, the anvil was covered with a Penrose drain, and then guided into the hilum. The spleen was extracted through the umbilical wound within a retrieval bag. The umbilical wound was closed with a 0-Vicryl for the fascia and 5-0 PDS for subcutaneous closure.

Results: SILS was successfully performed in 14 patients (88%). Only 1 patient (6%) required conversion to open surgery due to bleeding from the splenic hilum. In the other patient with a splenic aneurysm, an additional port was required. The intraoperative blood loss was 138±288 ml. Operative time was 215±79 minutes, the extracted spleen weight was 281±118 g, and the postoperative hospital stay was 5±3 days. All patients were discharged uneventfully. Postoperative follow-up of 21±12 months after surgery did not reveal any complications. The umbilical incision and the needle hole for tugging the spleen were completely invisible.

Conclusion: Using some technical refinements, SILS can be performed by experienced surgeons as safely as conventional laparoscopic splenectomy.

Session: Poster Presentation

Program Number: P655

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