Transumbilical single-incision laparoscopic splenectomy using conventional instruments: preliminary experience in consecutive patients and comparison to standard multiple-incision laparoscopic splenectomy

Ying Fan, Shuodong Wu. Department of the Second General Surgery, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, People’s Republic of China.

Background Application of single-incision laparoscopic surgery(SILS) technique in splenectomy is still in its infancy with limited literature reports for limited indications. The purpose of this study is to study the feasibility and safety of transumbilical single -incision laparoscopic splenectomy using conventional instruments in consecutive patients, and compare outcomes of the procedure to standard laparoscopy.

Methods A retrospective review was conducted to evaluate all transumbilical single-incision splenectomies performed by a single surgeon between March 2010 and January 2013. Additionally, patients who underwent standard laparoscopic splenectomy by other surgeons in the same surgical group during the same period were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed.

Results 13 patients underwent successful single-incision splenectomy during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 165 min. There was 7.7 % morbidity and no mortality in the study group. Median length of stay was 8.8 days. Additionally, 12 patients who underwent standard laparoscopic splenectomy were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. Single-incision splenectomy using conventional instruments was associated with reduced postoperative pain scores [(1.60±0.20) vs. (3.60±0.90) for postoperative day 1, P<0.01; (0.50±0.10) vs.(2.00±0.45) for postoperative day 2, P<0.01?, equivalent operative time, conversion rate, length of stay, similar mortality, morbidity, and cost. The umbilical incision of the single-incision group can be easily hidden in the umbilical fold with ideal cosmetic result.

Conclusions Single-incision splenectomy is feasible, safe, and efficient in an unselected patient population in the hands of an experienced laparoscopic surgeon. The single- incision technique is comparable to standard laparoscopic splenectomy in terms of operative time and perioperative outcomes. Reduced postoperative pain and ideal cosmetic effect may be its potential advantages.

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