Multiport Laparoscopic Splenectomy Research Articles

Improved outcome in laparoscopic splenectomy in children with benign hematological disease after standardization of techniques

Laparoscopic splenectomy has gained popularity in the management of children with benign hematological disease who required splenectomy. We aim to report the outcome after standardization of techniques in laparoscopic splenectomy. A retrospective study was conducted in which all children with benign hematological disease underwent laparoscopic splenectomy in our institute from 2003 to 2017. The demographics and outcomes before (Group 1) and after (Group 2) standardization of techniques were compared. The laparoscopic techniques were standardized in Group 2. They all underwent multiport laparoscopic splenectomy and the splenic pedicles were divided by bipolar sealing device (LigaSure). In Group 1, splenectomy could be performed by single port or multiple ports approach. The splenic pedicles could be divided by endovascular stapler or LigaSure. Group 1 included 14 children who underwent splenectomy from 2003 to 2010 and Group 2 included 9 children who were operated from 2011 to 2017. The demographics were comparable between the two groups. Group 2 was associated with lower complication (0 vs. 5, p = 0.043), shorter operative time in splenectomy (146 min vs. 173 min, p = 0.056) and shorter mean hospital stay (3.8 days vs. 7.1 days, p < 0.0001). Superior outcomes including lower complication rates and shorter hospital stay were observed after standardization of surgical techniques in laparoscopic splenectomy in children using multiple ports and LigaSure.

Clinical significance of single-port laparoscopic splenectomy: comparison of single-port and multiport laparoscopic procedure.

PurposeSingle-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease.MethodsBetween October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group.ResultsThe body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 ± 39.9 and 95.9 ± 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 ± 301.3 and 322.5 ± 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 ± 300.7 and 362.3 ± 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 ± 2.5 and 7.3 ± 5.2 days respectively (P = 0.140).ConclusionSingle-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery.

Feasibility and safety of single-incision laparoscopic splenectomy: a systematic review

ObjectiveThe aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic splenectomy (SILS-Sp). MethodsWe conducted a systemic review of literature between 2009 and 2012 to retrieve all relevant articles. ResultsA total of 29 studies with 105 patients undergoing SILS-Sp were reviewed. Fifteen studies used a commercially available single-port device. The range of body mass index was 14.7–41.4 kg/m2. Six studies described combined operations including cholecystectomy (n = 8), mesh-pexy (n = 1), and pericardial devascularizaion (n = 1). The ranges of operative times and estimated blood losses were 28–420 min and 0–350 mL, respectively. Of 105 patients, three patients (2.9%) required additional ports, two patients (1.9%) were converted to open, and three patients (2.9%) to conventional multiport laparoscopic splenectomy (overall conversion rate, 4.8%). Postoperative bleeding occurred in two patients (1.9%) who both required reoperation. Overall mortality was 0% (0/105). The length of postoperative stay varied across reports (1–11 d). Among four comparative studies, one showed greater estimated blood loss and lower numeric pain rating scale score in the SILS-Sp group than in the multiport laparoscopic splenectomy group (206.25 ± 142.45 versus 111.11 ± 99.58 mL) and (3.81 ± 0.91 versus 4.56 ± 1.29), respectively. Another comparative study showed that SILS-Sp was associated with a shorter operative time (92.5 versus 172 min; P = 0.003), lower conversion rate, equivalent length of hospital stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements. ConclusionsIn early series of highly selected patients, SILS-Sp appears to be feasible and safe when performed by experienced laparoscopic surgeons. However, as an emerging operation, publication bias is a factor that should be considered before we can draw an objective conclusion.

Minimally invasive splenectomy: an update and review.

Laparoscopic splenectomy (LS) has become an established standard of care in the management of surgical diseases of the spleen. The present article is an update and review of current procedures and controversies regarding minimally invasive splenectomy. We review the indications and contraindications for LS as well as preoperative considerations. An individual assessment of the procedures and outcomes of multiport laparoscopic splenectomy, hand-assisted laparoscopic splenectomy, robotic splenectomy, natural orifice transluminal endoscopic splenectomy and single-port splenectomy is included. Furthermore, this review examines postoperative considerations after LS, including the postoperative course of uncomplicated patients, postoperative portal vein thrombosis, infections and malignancy.

Single-Incision Laparoscopic Splenectomy Versus Conventional Multiport Laparoscopic Splenectomy

The authors report their experience with single-incision laparoscopic splenectomy (SLS) and compare postoperative outcomes of conventional multiport laparoscopic splenectomy (MLS) with SLS in patients with spleen sizes ≤15 cm. Demographic, intraoperative, and postoperative data were analyzed retrospectively and compared between patients who underwent MLS from June 20, 2006, to July 9, 2009 (MLS group, 18 patients) and those who underwent SLS from July 28, 2009, to November 2, 2010 (SLS group, 16 patients). Blood loss was significantly greater in the SLS group than in the MLS group (206.25 ± 142.45 vs 111.11 ± 99.58 mL, respectively; P = .047). The Numeric Pain Rating Scale in the SLS group was significantly lower than in the MLS group (3.81 ± 0.91 vs 4.56 ± 1.29, respectively; P = .041). There were no significant differences between the groups for other variables. SLS is a feasible method with good cosmetic benefit and equivalent clinical outcomes as compared with MLS.

Single-port splenectomy: Current update and controversies

Multiport laparoscopic splenectomy (LS) is considered the “gold standard” for the management of surgical diseases in normal or slightly enlarged spleens. The concept of minimal-invasive surgical techniques has progressed since the early 1990s from standard multiport laparoscopy to natural orifice transluminal endoscopic surgery (NOTES) and, more recently, to single-port access (SPA). In this paper, we describe our technique for SPA splenectomy and provide a critical review of the current literature on SPA for splenic diseases.Preliminary results published to date indicate that the spleen can be safely removed using single-incision surgery and all the authors have unanimously endorsed the feasibility of this approach. However, available evidence is still scarce. It is based only on case reports and one small series, with a total of 17 patents and, therefore, firm conclusions cannot yet be drawn and more experience and comparative trials are needed to determine the exact role of this interesting new approach.