Single Incision Laparoscopic Surgery for Splenectomy-ntuh Experience

Ching-yao Yang, MD PhD, I-rue Lai, MD PhD, Ray-hwang Yuan, MD PhD, Chiung-nien Chen, MD PhD, Yu-wen Tien, MD PhD, Ming-tsan Lin, MD PhD. Division of General Surgery, Department of Surgery, National Taiwan University Hospital


Single incision laparoscopic surgery (SILS) is a developing advanced laparoscopic technique in recent years. It was majorly applied in appendectomy, and cholecystectomy. But SILS laparoscopic splenectomy was reported in limited cases in the literature, and in Asia, it has only been reported from Korea. The purpose of this study is to report and share our experience of SILS laparoscopic splenectomy.
Methods and Procedures:
The clinical data and follow-up outcome were prospectively recorded in patients undergoing SILS laparoscopic splenectomy in June 2010. The perioperative parameters, morbidity, and follow-up results were analyzed.
All three cases were performed in June 2010. There’re one female, and two male patients with average 32.33 years old (10-57 years). Two patients was diagnosed as ITP, and another 10-year-old boy was a case of Burkitt lymphoma with suspected splenic abscess. All patients were placed in the right 45-degree decubitus position. A 2.5cm incision was made at three fingers below left subcostal margin of the first patient, and the following two cases has wound in umbilicus. Covidien SILS™ Port were inserted through the single incision. A flexible-tip 5-mm HD scope (Olympus) was used. Dissection was performed with 5-mm grasper and 5-mm harmonic scapel (Ethicon Endo-Surgery). Splenic hilum was transected with one EndoGIA (Covidien Autosuture Roticulator 45-2.0mm). Spleen was put in EndoBag. Resected spleen was fragmented in ITP cases. The bag was pulled out through the umbilical incision. Hemostasis was checked. The average operative time is 90 minutes (70-120 min), and average blood loss is 46.7cc (20-100cc). All patients had oral intake on postoperative day 1, and discharged uneventfully within 3 days.
SILS laparoscopic splenectomy is feasible, and safe. The major advantage of this advanced technique is better cosmetic outcome, and higher acceptable as a treatment option for female patients with thrombocytopenia. Due to limited experience, the advantage when comparing with conventional 3- or 4-port laparoscopic splenectomy need more comparative study in the future.

Session Number: Poster – Poster Presentations
Program Number: P605
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