Single-incision Laparoscopic Splenectomy Research Articles

Selection of surgical modality for massive splenomegaly in children

BackgroundLaparoscopic splenectomy (LS), a treatment for both benign and malignant splenic diseases, can prove technically challenging in patients with massive splenomegaly. In particular, the optimal surgical modality for treating massive splenomegaly in children remains controversial.MethodsThe clinicopathologic data of 289 pediatric patients undergoing splenectomy for massive splenomegaly were studied in a retrospective analysis. Accordingly, the patients were classified into the LS surgery group and open splenectomy (OS) surgery group. In the laparoscopy cohort, they were separated into two subgroups according to the method of surgery: the multi-incision laparoscopic splenectomy (MILS) and the single-incision laparoscopic splenectomy (SILS) surgery groups, respectively. Patient demographics, clinical data, surgery, complications, and postoperative recovery underwent analysis. Concurrently, we compared the risk of adverse laparoscopic splenectomy outcomes utilizing univariable and multivariable logistic regression.ResultsThe total operation time proved remarkably shorter in the OS group in contrast to the LS group (149.87 ± 61.44 versus 188.20 ± 52.51 min, P < 0.001). Relative to the OS group, the LS group exhibited lowered postoperative pain scores, bowel recovery time, and postoperative hospitalization time (P < 0.001). No remarkable difference existed in post-operation complications or mortality (P > 0.05). Nevertheless, the operation duration was remarkably longer in the SILS surgery group than in the MILS surgery group (200 ± 46.11 versus 171.39 ± 40.30 min, P = 0.02). Meanwhile, the operative duration of MILS and SILS displayed a remarkable positive association with splenic length. Moreover, the operative duration of SILS displayed a remarkable positive association with the age, weight, and height of the sick children. Splenic length proved an independent risk factor of adverse outcomes (P < 0.001, OR 1.378).ConclusionsFor pediatric patients with massive splenomegaly who can tolerate prolonged anesthesia and operative procedures, LS surgery proves the optimal treatment regimen. SILS remains a novel surgery therapy which may be deemed a substitutional surgery approach for treating massive splenomegaly.

Single-incision laparoscopic splenectomy in children with massive splenomegaly: A prospective, monocentric pilot study.

Single-incision laparoscopic splenectomy (SILS) remains a challenging procedure because of the technical difficulty. In this prospective study, we aimed to evaluate the efficacy and safety of SILS in children with massive splenomegaly. Pediatric patients with massive splenomegaly were recruited for SILS in a university-affiliated hospital. The data on patient demographics, clinical features, operative variables, and perioperative outcomes were collected prospectively and analyzed. According to the different surgical instruments, the patients were randomly assigned into two groups: the SILS with straight surgical instrument (SILS-S) group and the SILS with curved surgical instrument (SILS-C) group. A two-group comparative analysis was conducted using perioperative data from the different surgical instrumentation systems. A total of 120 patients were included, of which 103 patients (success group, 85.83%) had complete SILS, the other 17 (failure group, 14.17%) patients were converted to open (n = 4, 3.33%) or multi-incision laparoscopic surgery (n = 13, 10.83%). The major cause for surgical failure is uncontrollable bleeding (n = 14, 82.35%), and age, height, and weight were the risk factors for failure of SILS, but none of the parameters were independent risk factors. The blood loss in the success group was less than that in the failure group, but no significant differences in other operative and outcome indicators. For SILS, the mean (±SD) operative time was 188 (±48.70) minutes, the median intraoperative blood loss (min, max) was 20 (5, 290) ml, the mean (±SD) time of first anal exhaust was 23.9 (±7.73) hours, and the mean (±SD) postoperative hospital stay was 4.72 (±1.03) days. The median pain score was 3 on 1 day, and 1 on 3 days after the operation. Postoperative complications were identified in 8 (7.77%) cases. However, there were no peri-operative deaths in this series. The SILS-C group had a significantly shorter operation time than the SILS-S group (mean ± SD, 172 ± 44.21 vs. 205 ± 47.90 min). There were no significant differences between the two groups in other perioperative data (P < 0.05). SILS is a safe and feasible treatment in pediatric patients with massive splenomegaly, and curved surgical instrumentation has contributed to developing surgical manipulation.

Portal Vein Thrombosis Following Splenectomy in Children: Is There a Higher Rate When Using Single-Incision Laparoscopy?

Portal vein thrombosis can be a life-threatening complication associated with a splenectomy. Laparoscopic splenectomy has been suggested to cause an increased rate of portal vein thrombosis. Our study evaluated the rate of portal vein thrombosis in pediatric patients who underwent a splenectomy via single-site laparoscopy. A retrospective chart review was performed for all patients undergoing laparoscopic splenectomy from November 2012 to July 2019. Demographic data, operative details, postoperative imaging, and patient outcomes were obtained for analysis. Patients were contacted to determine if they had any complications for which they sought medical care elsewhere. There were 78 pediatric patients who underwent laparoscopic splenectomy over the 7-year period. The most common indication was sickle cell disease (70.5%). Single-incision laparoscopy was performed in 61.5% of the cases. Eight were converted to open. Eleven patients (14.1%) had a laparoscopic cholecystectomy performed during the same operation. The overall complication rate was 8.9%. A quarter of our patients had imaging within 1year of surgery; no portal vein thrombosis was identified. In addition, over half of the patients were recontacted for follow-up questioning. None of the patients surveyed sought medical care elsewhere for a surgery-related complication or sequela of a portal vein thrombus. Single-incision laparoscopic splenectomy is a safe approach in children. Using the single-site platform allows the flexibility to perform additional operations, such as cholecystectomy, without the placement of additional ports. This analysis shows that patients undergoing single-incision laparoscopic splenectomy do not have a higher rate for portal vein thrombosis.

Single-Incision Laparoscopic Splenectomy for a Large Non-Traumatic Pseudocyst of the Spleen: A Case Report

Introduction: The incidence of splenic cysts is low, and most are asymptomatic. Symptomatic splenic cysts have rarely been reported. Due to the unspecific clinical and radiologic features, the nature of a cyst is difficult to define in the absence of a history of trauma. Therefore, splenectomy is usually the treatment of choice for obtaining a specimen. In particular, total splenectomy has been the treatment of choice for removal of splenic cysts. Case Presentation: A 25-year-old male patient visited the outpatient department at Tri-Service General Hospital Penghu Branch, Taiwan, with the chief complaint of abdominal fullness. No obvious history of trauma was reported. A series of examinations were performed, and abdominal computed tomography showed one large splenic cyst within the splenic septum. We performed single-incision laparoscopic splenectomy, and the patient recovered well and returned to daily activities one week later. Conclusions: In this modern era of minimally invasive surgery, laparoscopic surgery has reduced postoperative pain and improved recovery, with no increase in complications. Laparoscopic splenectomy has become the trend for the management of splenic cysts. Although single-incision laparoscopic surgery is a technical challenge, better cosmetic results and decreased postoperative wound pain are considered to be superior outcomes compared with those of conventional multi-port laparoscopic surgery.

Systematic review and meta-analysis of single-incision versus conventional multiport laparoscopic splenectomy.

Background:There is no consensus that single-incision laparoscopic surgery splenectomy (SILS-SP) is on a par with conventional multiport laparoscopic surgery splenectomy (CMLS-SP).Aims:The aim of this systematic review and meta-analysis was to assess feasibility and safety of SILS-SP when compared with CMLS-SP.Materials and Methods:Eligible articles were identified by searching several databases including PubMed, EMBASE, CNKI (China) and the Cochrane Library, up until February 2016. Studies were reviewed independently and rated by Newcastle–Ottawa Quality Assessment Scale. Evaluated outcomes were complications, operative time, post-operative hospital stay, blood loss, starting diet, post-operative pain scores, conversion and analgesic requirements.Results:Ten retrospective studies met the eligibility criteria. Overall, there was no significant difference between SILS-SP and CMLS-SP in complications, operative time, post-operative hospital stay, blood loss, starting diet, post-operative pain scores, conversion and analgesic requirements.Conclusions:SILS-SP is feasible and safe in certain patients, with no obvious advantages over CMLS-SP. Therefore, it may be considered an alternative to CMLS-SP. We await high-quality, double-blind RCTs. These should include clear statements on standard scores of post-operative pain and cosmetic results, longer follow-up assessment and cost–benefit analysis.

Single-Incision Laparoscopic Splenectomy Using the Suture Suspension Technique for Splenomegaly in Children with Hereditary Spherocytosis.

With increasing laparoscopic surgery experience and improved new vessel-sealing equipment, single-incision laparoscopic surgery (SILS) for splenectomy has emerged as an alternative to multiport laparoscopy, but the application of SILS for splenomegaly is still challenging due to technical difficulties. The aim of this study was to describe the suture suspension technique contributing to SILS for hereditary spherocytosis (HS). A retrospective review was conducted to evaluate all SILS for splenomegaly performed by a single surgeon. On preoperative ultrasonography, the spleen size index ranged from 0.67 to 0.82. An umbilical incision was used for the placement of a multichannel single port. To provide excellent exposure of the splenic hilum, a needle with a 1-0 suture was percutaneously introduced from the left hypochondriac region and then penetrated out the anterior chest wall for suspending the enlarged spleen. Dissection was facilitated by the use of a 5-mm curved reusable grasper and a 5-mm Harmonic(®) scalpel (Ethicon Endo-Surgery, Cincinnati, OH), and the splenic vessels were ligated with 5-mm Weck(®) Hem-o-lok(®) clips (Teleflex(®), Morrisville, NC). The resected spleen was placed in an endosurgical bag, morcellated, and removed from the abdomen via the umbilical incision. Nine children underwent SILS during the study period without conversion to open procedures or requiring additional ports. The suture suspension technique was successfully used and markedly improved the exposure of the splenic hilum. The operative time was 122.6 ± 31.2 minutes, and the extracted spleen weight was 562 ± 74.5 g (range, 420-1260 g). No intraoperative or postoperative complications were recorded. The umbilical incision healed well with a satisfactory cosmetic effect. Our outcome shows the suture suspension enables safe and feasible usage of SILS for the management of splenomegaly in children with HS. More experience is needed to assess advantages and disadvantages compared with the standard laparoscopic approach.

Single-incision laparoscopic splenectomy with conventional instruments: preliminary experience in consecutive patients and comparison to standard multiple-incision laparoscopic splenectomy.

To study the feasibility and efficiency of transumbilical single-incision laparoscopic surgery splenectomy (SILS-Sp) using conventional instruments in consecutive patients and to compare outcomes of the procedure with those of standard multiple-incision laparoscopic splenectomy (MLS). A retrospective review was conducted to evaluate all SILS-Sp procedures performed by a single surgeon between March 2010 and January 2013. Additionally, patients who underwent MLS 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. Thirteen patients underwent successful SILS-Sp during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 165 minutes. 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 MLS were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. For MLS, the median operative time was 158 minutes. There was 8.3% morbidity and no mortality in the group. Median length of stay was 8.3 days. SILS-Sp using conventional instruments was associated with reduced postoperative pain scores, but this did not reach statistical significance. The operative time, conversion rate, and length of stay were equivalent. The mortality, morbidity, and cost were also similar in the two groups. The umbilical incision of the single-incision group can be easily hidden in the umbilical fold with ideal cosmetic result. SILS-Sp is feasible 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. Ideal cosmetic effect may be its potential advantage.

Single-incision laparoscopic splenectomy for massive splenomegaly combining gastroesophageal devascularization using conventional instruments.

Single-incision laparoscopic splenectomy has been reported and was proved to be feasible and safe. Yet reports on single-incision laparoscopic surgery (SILS) for massive splenomegaly is not seen, neither is SILS for gastroesophageal devascularization; another correlated procedure for patients complicated with bleeding esophageal varices. From February 2011 to March 2012, 6 male patients with a median age of 45.1 years (range, 25 to 65 y) who were diagnosed of liver cirrhosis, portal hypertension, splenomegaly, and hypersplenism underwent SILS by the same surgical team in our hospital. Of them, 4 patients who were indicated had combined gastroesophageal devascularization, except for 1 conversion to hand-assisted laparoscopic approach because of bleeding, the operations were performed uneventfully and the surgical outcomes were satisfactory. Preoperative diagnosis was hypersplenism secondary to liver cirrhosis, the surgical outcome was satisfactory. This video, Supplemental Digital Content 1 and 2, http://links.lww.com/SLE/A104 and http://links.lww.com/SLE/A105 illustrates the crucial steps regarding the SILS for massive splenomegaly combined with gastroesophageal devascularization. The preoperative diagnosis are, hepatitis B, the patient's liver function is Liver Child-Pugh grade A. The patient was placed in reverse Trendelenburg position, with the legs open. The surgeon was standing on the right side of the patient and an assistant standing in between the legs. One 20-mm incision was made under the umbilicus, a 10-mm Trocar (Johnson & Johnson Investment Co. Ltd., NJ) was introduced in the middle of the incision, and the abdominal cavity was explored with a 10-mm, 30-degree scope (Storz Co. Ltd., Germany). Then a 12-mm and a 5-mm trocar were introduced through the same incision, respectively, 45 degree to the 10-mm trocar at both sides to form a "∇" shape. The procedure started with the dissection of the splenocolic ligament at the lower pole of the spleen, followed by creating a window by dissecting the gastrocolic ligament. The secondary branches of splenic pedicle were dissected and divided. The dissection of splenogastric ligament was continued along the gastric greater curvature, and short gastric vessels were encountered and divided. The left gastric artery was clipped and secured, followed by gastroesophageal devascularization along the cardiac to the esophagus 5 cm away from the esophagocardia junction, with Ligasure device. The splenic artery was identified, clipped, and divided. The splenic vein was finally divided followed by intraoperative autologous blood transfusion technique by collecting the blood from the distal splenic vein. The spleen was removed from the umbilical incision in a sample bag after being sliced into pieces. A drainage was placed through the incision. The operation was successful and the patient recovered well postoperatively: the operation time was 265 minutes, and the intraoperative blood loss was 300 mL. The postoperative course was uneventful and the patient was discharged 13 days later. SILS combining gastroesophageal devascularization for massive splenomegaly is technically feasible in the hands of surgeons with experiences of laparoscopic splenectomy. Indeed, the relative large scale of operation field for laparoscopic splenectomy makes the conflicts of instruments less practically challenging; however, techniques and sequences of the laparoscopic procedures should be modified to facilitate it, given the unavoidable constriction of movements for each instrument.

Single incision laparoscopic splenectomy with hilar dissection for massive splenomegaly (with video)

Splenectomy;Laparoscopy;Single incision;Hilar dissection;SplenomegalyThe first laparoscopic splenectomy was performed in 1992 [1]. This approach is now thetechnique of choice for splenectomy. Single trocar surgery has been developed since theend ofthe1990s. Several teams have described advantages single trocar splenec-tomy [2,3]. However, most of these studies have been on relatively small size spleens withroutine stapling ofthesplenic hilum. This video shows technique single incisionsplenectomy withsplenic hilar dissection in a patient massive splenomegaly.A 16-year-old girl with hereditary spherocytosis requiring blood transfusions forsymptomatic anemia was referred for splenectomy. Abdominal MRI showed massivesplenectomy, measuring 21cm in the longitudinal axis.The patient was positioned supine, legs apart with the operator standing between thepatient’s legs while freeing the lower pole of the spleen, and then moving to the patient’sright side for the rest of the operation. A 2cm incision was made at the level of theumbilicus to insert a four port single trocar (Quadriport

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.

Single-incision laparoscopic splenectomy: preliminary experience in consecutive patients and comparison to standard laparoscopic splenectomy

Since first being described in 2009, single-incision laparoscopic splenectomy has been described in a limited number of case reports and small case series. No studies have evaluated single-incision splenectomy in unselected patients, and outcomes of the procedure have not previously been compared to standard laparoscopy. A retrospective review was conducted to evaluate all single-incision splenectomies performed by a single surgeon between June 2010 and June 2011. Additionally, patients who underwent standard laparoscopic splenectomy by surgeons in the same tertiary referral surgical oncology group were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed. Eight 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 92.5 min. There was 25 % morbidity and no mortality in the study group. Median length of stay was 4 days. Additionally, 18 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 was associated with a shorter operative time (92.5 vs. 172 min, p = 0.003), lower conversion rate, equivalent length of stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements. 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.

Single-incision laparoscopic splenectomy in children

PurposeSingle-incision laparoscopic surgery is being incorporated into the practices of many pediatric surgeons. Its superior cosmetic outcomes have resulted in increased patient- and parent-driven demand for the approach. This article describes a series of single-incision laparoscopic splenectomies (SSs) in children and compares outcomes with a historical series of standard laparoscopic splenectomies (LS). MethodsThe medical records of patients who underwent standard splenectomy and SS at our institution between 2007 and 2010 were reviewed. Perioperative data were recorded. Descriptive comparisons were made between the SS and LS groups. ResultsSeven patients underwent SS, and 4 underwent LS during the study period. Operative times for the SS group decreased as experience with the procedure accumulated and ultimately approached LS operative times. No conversions to a standard laparoscopic or open approach were required. No complications occurred. Length of stay and postoperative pain were similar in both groups. single-incision laparoscopic splenectomy provided excellent cosmetic outcomes. ConclusionsSingle-incision laparoscopic splenectomy is feasible in children. Its main benefit is improved cosmesis. It can be performed without detrimental increases in operative times or patient discomfort. Given an increased demand for the approach, it remains a viable option in children.

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.

Emergency Transumbilical Single-Incision Laparoscopic Splenectomy for the Treatment of Traumatic Rupture of the Spleen: Report of the First Case and Literature Review

The authors report 1 case of emergency splenectomy for the treatment of traumatic rupture of the spleen where a laparoendoscopic single-site surgery technique was performed. A 17-year-old male with a diagnosis of traumatic rupture of the spleen underwent emergency transumbilical single-incision laparoscopic splenectomy. Three ports, including 5 mm and 10 mm ports, were placed through a transumbilical incision for the procedure. Intraoperative and postoperative courses were uneventful. The patient was discharged home 8 days after the surgery in a stable condition. Discussion. The Laparoendoscopic single site surgery technique is still in its infancy, but because of its reduced invasion and ideal aesthetic results, it is well received by patients. Improvements are needed to widen its application. To the authors' knowledge, this is the first report where an emergency laparoendoscopic single site surgery technique has been used in the management of a ruptured spleen.

Single-incision laparoscopic splenectomy using the “tug-exposure technique” in adults: results of ten initial cases

The application of single-incision laparoscopic surgery (SILS) to splenectomy is still challenging with much room for technical improvement. The purpose of this study was to describe the tug-exposure technique, an innovative technique for performing safe single-incision laparoscopic splenectomy (SILS-Sp). We performed SILS-Sp in ten consecutive adult patients with a variety of pathology requiring total splenectomy. A SILS™ Port with three 5-mm trocars was placed in the umbilicus as a single-access site. A flexible 5-mm laparoscope and an articulating grasper were used in addition to standard laparoscopic equipment. A cloth tape was introduced intraperitoneally to encircle and tug the splenic hilum. Both ends of the tape were extracted through an extra needle hole in the skin. Pulling the tape in appropriate directions provided excellent exposure of the splenic hilum (the tug-exposure technique). Under sufficient tension and exposure by tugging the spleen, a linear stapler was introduced for stapling and dividing the splenic hilum and the splenic artery and vein. The spleen was extracted through the umbilical wound within a retrieval bag. The umbilical wound was closed with subcutaneous sutures. The tug-exposure technique was successfully used in all patients and markedly improved the exposure of the splenic hilum during SILS-Sp. The median intraoperative blood loss was 15 (range 0-1,000) ml. Only one patient (10%) required conversion to open surgery. Median operative time was 230 (range, 150-378) min, the median extracted spleen weight was 260 (range, 100-580) g, and the median postoperative hospital stay was 7 (range, 4-9) days. All patients were discharged uneventfully. The umbilical incision was nearly invisible at the 1-month follow-up. The tug-exposure technique is an innovative technique that enables easy and safe SILS splenectomy by experienced surgeons.

Single-incision laparoscopic splenectomy with innovative gastric traction suture

Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP) undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL) splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

Technical Report on the Initial Cases of Single-Incision Laparoscopic Combined Cholecystectomy and Splenectomy in Children, Using Conventional Instruments

The authors report a technique to perform single-incision laparoscopic combined cholecystectomy and splenectomy in 3 children using conventional instruments. Three ports, including 5-mm and 3-mm ports, were placed through an infraumbilical incision for the procedure. Splenectomy was completed in most parts by crossing the 2 straight instruments. The 3 patients, aged 11 to 13 years, with body weight 29 kg to 32 kg, underwent the procedure. In the first patient, 2 additional extraumbilical 5-mm ports were required to complete the splenectomy. After modification of the technique, combined cholecystectomy and splenectomy by SILS were successfully performed in the other 2 patients without complications, and postoperative courses were uneventful. Combined cholecystectomy and splenectomy in children by SILS is technically feasible using conventional instruments. Further studies are required to investigate its safety, benefits over conventional laparoscopic surgery, and refinements in the technique.

Single Incision Laparoscopic Splenectomy in a 5-Year-Old With Hereditary Spherocytosis

Single incision laparoscopic surgery (SILS) is an emerging technique that has been used as an approach for appendectomy, cholecystectomy, and splenectomy. We describe the technique of single incision laparoscopic splenectomy for hypersplenism in a 5-year-old boy with spherocytosis. The patient required blood transfusions for anemia secondary to hypersplenism. His spleen measured 9.8 cm in cranio-caudal length on ultrasound. SILS splenectomy was performed through a 2-cm umbilical incision by using 3 ports. The splenic attachments were taken down using an electrosurgical sealing and cutting device, and the hilum was transected with an endosurgical stapler. The spleen was placed in an endosurgical bag, morcellated, and removed from the abdomen via the umbilical incision without complications. Operative time was 84 minutes; blood loss was minimal. SILS splenectomy is feasible in pediatric patients. More experience is needed to assess advantages and disadvantages compared with the standard laparoscopic approach.

Single Incision Laparoscopic Splenectomy. Our First Experiences.

Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences. Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively. Results: There were 7 patients (5 females and 2 males) with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure. Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.