Takeyuki Misawa, MD1, Shuichi Fujioka1, Hiroaki Kitamura1, Yu Kumagai1, Tadashi Akiba1, Katsuhiko Yanaga2. 1Department of Surgery, The Jikei University Kashiwa Hospital, 2Department of Surgery, The Jikei University School of Medicine
Aim: While conventional multiport laparoscopic splenectomy has become gold standard for some hematological or splenic diseases, reduced-port laparoscopic splenectomy (RPLS) including single-incision laparoscopic splenectomy (SILS) is regarded as highly challenging. Herein, we describe the technical refinements for safe RPLS especially for patient with splenomegaly.
Methods: In all cases, access was achieved via a 2.5-cm mini-laparotomy at the umbilicus into which a SILSTM Port or E-Z Access® with three 5-mm trocars was placed. A 5-mm flexible scope, an articulating grasper, and straight instruments were used. Our RPLS is characterized by the followings: a) early ligation of the splenic artery to shrink the spleen, b) application of our original “tug exposure technique,” which provides good exposure of the splenic hilum by retracting (tugging) the spleen with a cloth tape, and c) safe introduction of stapler under the guidance with a flat drain into the splenic hilum
Results: 27 RPLS patients (12 men and 15 women, 43±19 years old) comprised hematological disorder (n=12), splenic disease (n=12), and liver cirrhosis (n=3). In 24 patients (89%), RPLS was successfully completed: SILS in 22 and SILS plus one additional port only in 2 patients. Conversion to open surgery was necessary in 3 patients including 1 liver cirrhosis with remarkable collateral varicose veins around the spleen. Operation time and blood loss were 214±78min and 166±312g, respectively. Weight of the extracted spleen was heavier than normal and 341±286g (maximum 960g). No intra- or postoperative complication occurred. The postoperative scar was nearly invisible.
Conclusions: RPLS might safely be performed even for splenomegaly (up to 1,000g). However, care should be taken for cirrhotic patient with collateral veins. RPLS can be the procedure of choice even in the patients with splenomegaly and who are concerned about postoperative cosmesis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87212
Program Number: P828
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster