Laparoendoscopic single site (LESS) splenectomy with a conventional laparoscope and instruments

JSLS. Jul-Sep 2011;15(3):384-6. doi: 10.4293/108680811X13125733356918.

Abstract

Background and objectives: We present 2 cases of laparoendoscopic single site surgery (LESS) splenectomy performed with a conventional laparoscope and instruments, and the use of a novel internal retraction device.

Methods: One patient underwent LESS splenectomy for idiopathic thrombocytopenia purpura (ITP), and a pediatric patient with sickle cell disease underwent LESS splenectomy and cholecystectomy. In each case, a 2-cm vertical incision was made within the confines of the umbilical ring, and a SILS port (Covidien, Norwalk CT) inserted. A 5-mm, 30-degree laparoscope and standard 5-mm instruments were used. After isolation of the splenic hilum, one 5-mm trocar of the SILS port was upsized to 12mm, and a laparoscopic stapler was used to divide the splenic artery and vein. An internal retractor consisting of a laparoscopic bulldog clamp with a hook attachment was used to retract the gallbladder, and to secure the specimen retrieval bag during splenic extraction, which eliminated the need for a fourth trocar.

Results: Total operative time was 160 minutes for the LESS splenectomy, and 216 minutes for the LESS splenectomy and cholecystectomy. Both procedures were successfully completed with conventional instrumentation and a SILS port, without the need for additional incisions or trocars. No complications occurred, and both patients had an uneventful recovery.

Conclusions: LESS splenectomy is a feasible procedure that can be performed safely. Although articulating instruments and laparoscopes may offer advantages, they are not necessary for performing LESS splenectomy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anemia, Sickle Cell / surgery*
  • Cholecystectomy, Laparoscopic
  • Equipment Design
  • Female
  • Humans
  • Laparoscopes
  • Laparoscopy / instrumentation
  • Laparoscopy / methods*
  • Purpura, Thrombocytopenic, Idiopathic / surgery*
  • Splenectomy / instrumentation*
  • Splenectomy / methods*