Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.258
Revised: October 10, 2013
Accepted: October 17, 2013
Published online: January 7, 2014
AIM: To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.
METHODS: Between 2010 and 2012, transumbilical single-incision endoscopic splenectomy was performed in 10 patients in our department, of whom 4 had refractory idiopathic thrombocytopenic purpura, 4 had enlarged splenic cyst and 2 had splenic hematoma. A 2.5-cm curved incision was made at the lower umbilicus edge, and a 10 mm laparoscope was inserted into the middle of the incision. A 5-mm harmonic scalpel was placed on the right side, and a 5-mm auxiliary instrument on the left side of the laparoscope. Splenic ligaments were incised with a harmonic scalpel, and the splenic pedicle was cut with an Endo-gastrointestinal anastomosis. The spleen was dissected and placed in a large retrieval bag, blended, and then removed.
RESULTS: All transumbilical single-incision endoscopic splenectomies were performed successfully with mean operative time of 80 ± 5 min and mean blood loss of 150 ± 20 mL. Conversion to laparotomy or multi-port laparoscopic surgery was not required in all cases. All patients were discharged on postoperative days 4-6. During the postoperative hospitalization period, no painkillers were required. No intra-abdominal complications such as infection, ascites, gastric leakage, pancreatic leakage, or wound infection occurred in any case during the 6-mo follow-up.
CONCLUSION: Transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments is technically feasible and safe in selected patients.
Core tip: Laparoscopic splenectomy has been recognized worldwide and has gradually replaced conventional laparotomy. It is the first choice of splenectomy for diseased spleens < 20 cm in diameter, especially for spleens with hematological diseases. Minimally invasive surgery has developed with the increasing demand for better cosmetic outcomes. For this reason, single-incision endoscopic techniques have emerged and become the latest research focus of minimally invasive surgery. In this report, we demonstrated our successful performance of transumbilical single-incision endoscopic cholecystectomy in 10 patients with benign lesions using conventional laparoscopic instruments.