The Alexis\xae system for laparoscopic splenectomy in pediatric patients

Emanuele Trovalusci,Cristina Pizzato,Marco Gasparella,Paola Midrio

doi:10.1007/s13304-021-01023-5

Emanuele Trovalusci, Cristina Pizzato + Show 2 more

Open Access

https://doi.org/10.1007/s13304-021-01023-5

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Abstract

The laparoscopic splenectomy in pediatric patients is performed worldwide but often the disproportion between size of patients and size of organs requires an extra laparotomic access for spleen removal. The aim of the present study was to evaluate the safety and effectiveness of the Alexis® system to retrieve the spleen without additional laparotomic access. The charts of all patients who underwent splenectomy at our center during the last 5 years were retrieved. In all the cases the Alexis® system was placed in the umbilicus, thru which a 10 mm camera was inserted. Three additional 5 mm standard trocars were inserted. Seven patients, affected by spherocytosis (3), epidermoid cyst (2), idiopathic thrombocytopenic purpura (2) and thalassemia (1), underwent laparoscopic splenectomy at a median age of 10 years (range: 8–17). Median patients’ weight was 32.5 kg (range: 25–71) and spleen size 15 cm (11–18). In all the cases, upon removal of the camera, the retrieval bag was inserted thru the umbilicus under direct view, the spleen retrieved, morcellated, and removed. No conversion nor enlargement of one of the ports nor an extra laparotomic access were required. The patients were discharged on the fifth post-operative day and the cosmetic results were excellent. Removal of the spleen can be safely performed without any additional laparotomy thru the Alexis® system placed in the umbilicus. This system is effective also in case of major patient/organ size disproportion and the final cosmetic aspect is excellent.

Highlights

Splenectomy is usually performed as treatment of hematologic diseases, such as hereditary spherocytosis (HS), idiopathic thrombocytopenic purpura (ITP) or sickle cell disease (SCD), to slow down the blood cells turnover [1]
Despite the attractiveness this technique gained over time among general and pediatric surgeons, some authors were skeptical about the real benefits compared to the open approach
Aim of this study is to demonstrate that the use of the Alexis® wound retractor system can further improve this technique overcoming the problem of large spleen retrieval and better cosmetic outcome for the patient

Summary

Introduction

Splenectomy is usually performed as treatment of hematologic diseases, such as hereditary spherocytosis (HS), idiopathic thrombocytopenic purpura (ITP) or sickle cell disease (SCD), to slow down the blood cells turnover [1]. A breakthrough in the management of these patients was the advent of the laparoscopic splenectomy, performed for the first time in 1991 by general surgeon Delaitre [3] and, only 2 years after, by Tulman in the pediatric population [4]. Despite the attractiveness this technique gained over time among general and pediatric surgeons, some authors were skeptical about the real benefits compared to the open approach. An open issue remains the extraction of voluminous organs from small patients that require either an extra laparotomic access or the enlargement of one of the trocar site [10, 11]

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