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Surgical Endoscopy

, 25:3419 | Cite as

Single-access transumbilical laparoscopic splenectomy using curved reusable instruments

  • Giovanni DapriEmail author
  • Dominique Bron
  • Jacques Himpens
  • Lorenzo Casali
  • Pietro Carnevali
  • Pavlos Koustas
  • Guy-Bernard Cadière
Dynamic Manuscript

Abstract

Background

The authors report a single-access transumbilical laparoscopic splenectomy (SATLS) performed with curved reusable instruments.

Methods

A 23-year-old female consulted for steroid-resistant idiopathic thrombocytopenic purpura and clinical evidence of secondary Cushing syndrome. Preoperative workup showed a normal-sized spleen and thrombocytopenia. The umbilicus was incised and a purse-string suture was applied. A reusable 11-mm trocar was inserted for a 10-mm, 30° angled scope. Curved reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany) were advanced without trocars transumbilically. After opening the splenocolic and gastrosplenic ligaments, the main splenic artery and vein were dissected off at the level of the hilum, clipped with 5-mm clips introduced transumbilically, and sectioned. Posterior splenic attachments were freed at the hilum cranially and caudally. The spleen was finally retrieved transumbilically in a plastic bag.

Results

Addition of supplementary trocars or incisions was not necessary. Operative time was 180 min and final umbilical scar 16 mm. The patient was discharged on postoperative day 3, and after 6 months she was doing well.

Conclusions

SATLS was feasible and safe to be performed using curved reusable instruments. The curves of the instruments permitted the surgeon to work in an ergonomic position, without the instruments clashing thanks to the obtained triangulation. Since only reusable instruments were used, the cost of SATLS remained similar to that of standard laparoscopy.

Keywords

Single access Single port Single incision Laparoscopy Splenectomy Idiopathic thrombocytopenic purpura 

Notes

Disclosures

Giovanni Dapri is a consultant for Karl Storz-Endoskope (Tuttlingen, Germany). Dominique Bron, Jacques Himpens, Lorenzo Casali, Pietro Carnevali, Pavlos Koustas, and Guy-Bernard Cadière have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 59824 kb)

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Giovanni Dapri
    • 1
    Email author
  • Dominique Bron
    • 2
  • Jacques Himpens
    • 1
  • Lorenzo Casali
    • 1
  • Pietro Carnevali
    • 1
  • Pavlos Koustas
    • 1
  • Guy-Bernard Cadière
    • 1
  1. 1.Department of Gastrointestinal Surgery, European School of Laparoscopic SurgerySaint-Pierre University HospitalBrusselsBelgium
  2. 2.Department of Clinical and Experimental HematologyInstitut Jules BordetBrusselsBelgium

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