Single Incision Laparoscopic Splenectomy

Abstract

Laparoscopic surgery has been widely accepted as an alternative to open surgery across a myriad of surgical disciplines. Its benefits of diminished pain, faster recovery, improved cosmesis, and shorter hospitalization have been well documented across a spectrum of surgical procedures. SPA Splenectomy is a new technique through which Laparoscopic splenectomy takes place through a single incision usually the umbilicus, because it represents a natural scar and constitutes a well-healing site of access to the peritoneal cavity without need for additional ports. The current trend is to improve the cosmetic outcome when applying minimally invasive procedures if feasible, and single-port surgery is one of the options to achieve this goal. The difficulty with working through a small single incision can be summarized by the limited triangulation obtained by the classic straight instruments, the restricted degrees of freedom of their movements, the contact /proximity between the instruments during the operation and limited visual axis and operative field .These difficulties have been resolved in SILS, by the introduction of articulating instruments, where the straight shaft is supported by flexible tips and rotatable handles. SPA splenectomy potentially allows for better cosmesis, less pain and faster recovery, less wound infections, ease of tissue retrieval, combination procedure, patient acceptance,standard instruments can be used and do not violate natural orifices. The disadvantages of SPA splenectomyinclude loss of triangulation, “Sword-fighting” and hand crossing, the retraction may be problematic, Learning curve, Increased costs and Increased incidence of hernias .