Single Port Laparoscopic Splenectomy

Abstract

The introduction of laparoscopy in the early 1990s ushered in a new era in the surgical treatment of human diseases. Other less invasive procedures such as SILS-Sp have been applied to splenic surgery since Barbaros first reported in 2009. Theoretically, increase in the number of incisions and port sites can increase the incidence of abdominal wall hernia and wound infection. SILS-Sp could potentially minimize these complications. On the contrary, the length of skin incision is partly determined by the size of a resected specimen, which is especially true in cases of splenic malignancies that require integral specimens for histologic analysis. The use of a single incision for laparoscopic surgery minimizes abdominal trauma and has the theoretical advantages of shorter postoperative stay, reduced postoperative pain, and fewer complications. It is thought that SILS-Sp is indicated in patients with hematological disorders, including idiopathic thrombocytopenia purpura, thalassemia, hairy cell leukemia, lymphoma, myelofibrosis, or hereditary spherocytosis; patients with benign occupying lesion, including splenic hemangioma and splenic cyst, and some patients with portal hypertension requiring splenectomy. Patients with severe cardiorespiratory dysfunction, severe refractory coagulopathy, morbid obesity, pregnancy, and megalosplenia (>30 cmin diameter) are contraindicated. Various operative parameters including operative time and EBL are generally acceptable in this review. Particularly, the rate of conversion to open procedure (1.9%) is acceptable in these series of SILS-Sp. Single-incision laparoscopic splenectomy was associated with a significantly lower conversion to open rate, shorter operative time, and similar median estimated blood loss. The overall mortality (0%) and morbidity (2.1%) in these series of SILS-Sp are acceptable. The average/median length of hospital stay varied from 1 to 11 d across reports. Comparative studies reported that there were no significant differences between the groups in average length of hospital stay. One of the greatest challenges to more widespread use of single-incision splenectomy is the greater technical demands of the operation. For single-incision techniques in general, dissection and exposure are more difficult to perform due to loss of triangulation and decreased range of motion to maneuver instruments. Single-incision splenectomy has even greater technical demands because solid organs such as the spleen cannot be grasped and retracted. Because SILS-Sp procedure requir