Single Port Access: A Feasible Alternative to Conventional Laparoscopic Splenectomy

Laparoscopic approach is the gold standard for splenectomy . There is currently a trend to reduce the invasiveness of minimally invasive procedures. Single port access is alternative to NOTES but no reports have yet been published in relation to the spleen. AIM: To describe the SAP technique for splenectomy MAT. & METH.. 2 patients were approached by SAP: a 26-yr male diagnosed of IPT and a 45-yr male with recurrent Hodgkin disease. Surgical technique: It was divided into 5 steps: 1.- Patient position: standard right decubitus with the table flexed at the flank, 2. – Transumbilical trocar insertion: A 15 mm periumbilical incision and a flexible tip 10 mm HD scope through a 12 mm bladeless trocar bluntly introduced under optic contro. Two 5 mm trocar with a flexible corrugate shaft was inserted to the right and left. 3.- Splenic dissection. A 5 mm curved grasper used for TEM was placed through the left trocar and a 5 mm Ultracision on the right. Using this approach it was possible to mobilize the splenic colon flexure and to section the short vessels, The table was tilted to the left and the posterior spleno-renal attachments were freed. 4.- Splenic hilum transection: The flexible scope was retrieved and visual control was changed to a 5 mm scope introduced through the right 5 mm trocar. A 6 cm cartridge stapler was inserted through the 12 mm trocar and was applied several times to sever the splenic hilum. 5.- Spleen extraction. Once the spleen was completely free, a 15 mm endobag was inserted, replacing the 12 mm trocar. The spleen was grasped and introduced in the bag and the spleen was morcellated The mean op time was 90’ and blood loss was minimal. Spleen weight was 200 gr. and 450 gr..RESULTS: The postoperative course was uneventful. Both patients had minimal postoperative pain and scarring, and were discharged on the second postoperative day. CONCLUSIONS: SAP access can be safely used for operative visualization, hilum transection and spleen removal with conventional instrumentation, reducing parietal wall trauma to a minimum. The clinical, esthetic and functional advantages require further analysis.

Session: Podium Video Presentation

Program Number: V040

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