Laparoscopic single port splenectomy

A technique for single port splenectomy in a normal sized spleen and using a single 2cm subcostal incision is demonstrated. This approach was chosen to allow the use of a straight (non-articulated) 5mm Ligasure device. This was used to divide the gastrosplenic ligament and short gastric vessels, to seal in continuity the splenic artery, divide the lienorenal ligament and seal and divide the splenic hilar vessels. The SILS port easily accommodated a 15mm port for passage of large retrieval bag without excessive distraction of the incision.

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Laparoscopic single port splenectomy

Authors

Z Krukowski, I Ahmed

Abstract

A technique for single port splenectomy in a normal sized spleen and using a single 2cm subcostal incision is demonstrated. This approach was chosen to allow the use of a straight (non-articulated) 5mm Ligasure device. This was used to divide the gastrosplenic ligament and short gastric vessels, to seal in continuity the splenic artery, divide the lienorenal ligament and seal and divide the splenic hilar vessels. The SILS port easily accommodated a 15mm port for passage of large retrieval bag without excessive distraction of the incision.

Classification

new techniques, single port

Keywords

Laparoscopic single port splenectomy

Media type

Surgical video

Duration

05'40''

Publication

2009-07

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E-publication

WeBSurg.com, Jul 2009;9(07).
URL: http://www.websurg.com/doi-vd01en2705.htm

Laparoscopic single port splenectomy

1. Introduction 00'17''

This video demonstrates a laparoscopic single port splenectomy in a young woman with relapsed idiopathic thrombocytopenic purpura and a normal sized spleen. The Covidien SILS port was used. With the patient in a right lateral position, a 2cm subcostal incision was made.

2. Single port device insertion 00'44''

Through the muscle-splitting incision, the lubricated port was inserted. The three trocars were inserted in a staggered fashion. The pneumoperitoneum was established and a 5mm laparoscope inserted. A normal spleen was evidenced.

3. Division of splenic lower pole adhesions 01'37''

Using a 5mm atraumatic grasper and a 5mm Ligasure coagulating device, adhesions to the lower pole of the spleen were divided. A window was made into the lesser sac.

4. Splenic artery dissection 02'18''

Using a dissecting forceps, the splenic artery was mobilised off the superior aspect of the pancreas. The artery was coagulated in continuity, but not divided, using the Ligasure device.

5. Lienorenal ligament division 03'16''

The lienorenal ligament was divided to the upper pole of the spleen. Subcostal placement of the incision permitted the use of straight instruments and telescope.

6. Division of hilar vessels 03'47''

The remaining hilar vessels were then sequentially divided after coagulation with the Ligasure device on the proximal aspect. The spleen was completely detached. The 5mm ports were removed and a 15mm port inserted. A 5mm port was reinserted for the telescope. The 15mm port permitted the insertion of a 15mm Endo-catch retrieval bag. The semi-rigid nature of this allowed capture of the spleen without any additional instrument.

7. Specimen extraction 04'59''

Once in the bag, the bag was closed, the ports and the bag extracted. The spleen was morcellated in the bag using sponge holding forceps. The small size of the puncture and its muscle-splitting nature is evident. The patient was discharged within 24 hours of the procedure.