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Single port access (SPA) splenectomy.

Rottman SJ, Podolsky ER, Kim E, Kern J, Curcillo PG - JSLS (2010 Jan-Mar)

Bottom Line: Single port access (SPA) surgery was developed as an alternative to traditional multiport laparoscopy, potentially exploiting the already proven benefits of minimally invasive surgery.The single-port access technique has been successfully applied to splenectomy as an available alternative to multiport laparoscopic splenectomy.SPA surgery may be more ergonomically pleasing to the surgeon and offer patient benefits, such as faster recovery and decreased adhesion formation in the long term.

View Article: PubMed Central - PubMed

Affiliation: Drexel University College of Medicine, Department of Surgery, Philadelphia, Pennsylvania, USA.

ABSTRACT

Introduction: Over the last decade, laparoscopic splenectomy has become the standard of care for spleen removal. Elimination of a large incision and difficult exposure has decreased postoperative morbidity and length of stay. Single port access (SPA) surgery was developed as an alternative to traditional multiport laparoscopy, potentially exploiting the already proven benefits of minimally invasive surgery. We apply the SPA technique to splenectomy via a single umbilical incision.

Methods: SPA splenectomy was performed in a 36-year-old male for staging. The single-port access technique was used to gain abdominal entry. Exposure, dissection, and removal were performed via a single incision within the umbilicus. The final incision was extended for removal of a complete specimen for pathologic evaluation.

Results: Splenic mobilization and control of the short gastrics was successfully performed via a single umbilical incision. The final incision was extended inferiorly for en bloc organ removal. Follow-up at 18 months revealed a well-healed incision with no signs of hernia formation.

Conclusions: The single-port access technique has been successfully applied to splenectomy as an available alternative to multiport laparoscopic splenectomy. Use of standard instrumentation and trocars maintains costs and familiarity of the procedure. Exposure, visualization, and dissection are the same as in standard laparoscopy. SPA surgery may be more ergonomically pleasing to the surgeon and offer patient benefits, such as faster recovery and decreased adhesion formation in the long term.

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Related in: MedlinePlus

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Figure 5: Final incision.

Mentions: A 36-year-old African American male underwent splenectomy for staging of lymphoma. The standard SPA technique was used for abdominal entry. A 12-mm incision was made at the umbilicus. Blunt dissection was performed until fascia was exposed. A 5-mm clear trocar was passed through the fascia, and the abdominal cavity was insufflated with carbon dioxide to a standard pressure of 15mm. A 5-mm laparoscope was introduced. The abdominal cavity was explored. Skin and soft tissue flaps were raised in both directions lateral to the midline trocar (Figure 1). Two accessory trocars were then inserted superior and lateral to the initial trocar. Each trocar was introduced through separate fascial locations within the single umbilical incision (Figure 2a, b). Using a 30° scope through the clear central trocar, we are able to observe the second and third trocar entering the abdominal cavity safely. Once access was obtained, the intraabdominal procedure was virtually the same as multiport laparoscopy (Figure 3). First, the splenocolic ligament was taken down with a Harmonic scalpel. The patient was then placed in a reverse Trendelenburg position with the right side down to promote better visualization. Next, the posterior attachment to the diaphragm was released, and the short gastrics were transected. The inferior attachments of the spleen were freed by using a Harmonic scalpel and LigaSure. A 5mm trocar was then upsized to a 12mm trocar to accomodate the stapler. The splenic artery and vein were divided by using a stapling device. The stapling device was fired several times across the splenic hilum (Figure 4). At this point, the spleen was mobilized completely and retracted inferiorly. The left upper quadrant was irrigated and inspected for adequate hemostasis. The patient was placed in a flat position. The spleen was placed in an endocatch bag, and the umbilical incision was extended inferiorly to allow for extraction of the spleen. The trocars were removed, the abdomen desufflated, the fascia was re-approximated, and the skin was closed (Figure 5).


Single port access (SPA) splenectomy.

Rottman SJ, Podolsky ER, Kim E, Kern J, Curcillo PG - JSLS (2010 Jan-Mar)

Final incision.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021308&req=5

Figure 5: Final incision.
Mentions: A 36-year-old African American male underwent splenectomy for staging of lymphoma. The standard SPA technique was used for abdominal entry. A 12-mm incision was made at the umbilicus. Blunt dissection was performed until fascia was exposed. A 5-mm clear trocar was passed through the fascia, and the abdominal cavity was insufflated with carbon dioxide to a standard pressure of 15mm. A 5-mm laparoscope was introduced. The abdominal cavity was explored. Skin and soft tissue flaps were raised in both directions lateral to the midline trocar (Figure 1). Two accessory trocars were then inserted superior and lateral to the initial trocar. Each trocar was introduced through separate fascial locations within the single umbilical incision (Figure 2a, b). Using a 30° scope through the clear central trocar, we are able to observe the second and third trocar entering the abdominal cavity safely. Once access was obtained, the intraabdominal procedure was virtually the same as multiport laparoscopy (Figure 3). First, the splenocolic ligament was taken down with a Harmonic scalpel. The patient was then placed in a reverse Trendelenburg position with the right side down to promote better visualization. Next, the posterior attachment to the diaphragm was released, and the short gastrics were transected. The inferior attachments of the spleen were freed by using a Harmonic scalpel and LigaSure. A 5mm trocar was then upsized to a 12mm trocar to accomodate the stapler. The splenic artery and vein were divided by using a stapling device. The stapling device was fired several times across the splenic hilum (Figure 4). At this point, the spleen was mobilized completely and retracted inferiorly. The left upper quadrant was irrigated and inspected for adequate hemostasis. The patient was placed in a flat position. The spleen was placed in an endocatch bag, and the umbilical incision was extended inferiorly to allow for extraction of the spleen. The trocars were removed, the abdomen desufflated, the fascia was re-approximated, and the skin was closed (Figure 5).

Bottom Line: Single port access (SPA) surgery was developed as an alternative to traditional multiport laparoscopy, potentially exploiting the already proven benefits of minimally invasive surgery.The single-port access technique has been successfully applied to splenectomy as an available alternative to multiport laparoscopic splenectomy.SPA surgery may be more ergonomically pleasing to the surgeon and offer patient benefits, such as faster recovery and decreased adhesion formation in the long term.

View Article: PubMed Central - PubMed

Affiliation: Drexel University College of Medicine, Department of Surgery, Philadelphia, Pennsylvania, USA.

ABSTRACT

Introduction: Over the last decade, laparoscopic splenectomy has become the standard of care for spleen removal. Elimination of a large incision and difficult exposure has decreased postoperative morbidity and length of stay. Single port access (SPA) surgery was developed as an alternative to traditional multiport laparoscopy, potentially exploiting the already proven benefits of minimally invasive surgery. We apply the SPA technique to splenectomy via a single umbilical incision.

Methods: SPA splenectomy was performed in a 36-year-old male for staging. The single-port access technique was used to gain abdominal entry. Exposure, dissection, and removal were performed via a single incision within the umbilicus. The final incision was extended for removal of a complete specimen for pathologic evaluation.

Results: Splenic mobilization and control of the short gastrics was successfully performed via a single umbilical incision. The final incision was extended inferiorly for en bloc organ removal. Follow-up at 18 months revealed a well-healed incision with no signs of hernia formation.

Conclusions: The single-port access technique has been successfully applied to splenectomy as an available alternative to multiport laparoscopic splenectomy. Use of standard instrumentation and trocars maintains costs and familiarity of the procedure. Exposure, visualization, and dissection are the same as in standard laparoscopy. SPA surgery may be more ergonomically pleasing to the surgeon and offer patient benefits, such as faster recovery and decreased adhesion formation in the long term.

Show MeSH
Related in: MedlinePlus