Laparoscopic single port splenectomy for idiopathic thrombocytopenic purpura (ITP)

This video demonstrates a laparoscopic single port splenectomy in a 27-year-old woman with medically refractory idiopathic thrombocytopenic purpura (ITP). The procedure was performed using a multi-instrument flexible single incision port, SILS port (Covidien), which was inserted through a 2.5cm left upper quadrant incision. A standard splenectomy was performed through this port by using the Ligasure® device (Covidien), a laparoscopic linear stapling device and articulated instruments. The procedure time was just over 2 hours. The patient was discharged within 24 hours of the procedure.

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Laparoscopic single port splenectomy for idiopathic thrombocytopenic purpura (ITP)

Authors

F Cianchi, G Perigli, E Qirici

Abstract

This video demonstrates a laparoscopic single port splenectomy in a 27-year-old woman with medically refractory idiopathic thrombocytopenic purpura (ITP). The procedure was performed using a multi-instrument flexible single incision port, SILS port (Covidien), which was inserted through a 2.5cm left upper quadrant incision. A standard splenectomy was performed through this port by using the Ligasure® device (Covidien), a laparoscopic linear stapling device and articulated instruments. The procedure time was just over 2 hours. The patient was discharged within 24 hours of the procedure.

Classification

single port, contribution

Keywords

Laparoscopic, single port, splenectomy, idiopathic, thrombocytopenic, purpura

Media type

Surgical video

Duration

11'17''

Publication

2010-11

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E-publication

WeBSurg.com, Nov 2010;10(11).
URL: http://www.websurg.com/doi-vd01en3102.htm

Laparoscopic single port splenectomy for idiopathic thrombocytopenic purpura (ITP)

1. Introduction 00'09''

This video demonstrates a laparoscopic single port splenectomy in an otherwise healthy 27-year-old woman with medically refractory idiopathic thrombocytopenic purpura and a platelet count of 3000. A preoperative CT-scan demonstrated a normal-sized 13.5cm spleen. The patient was placed in a 60-degree right lateral decubitus position and a 2.5cm left upper quadrant incision was made just lateral to the rectus muscle.

2. Single port system positioning 01'32''

A multi-instrument flexible port, SILS port (Covidien), was then inserted through the incision. Three 5mm trocars were placed through the port. A 5mm, 30-degree laparoscope whose light cord emerged straight from the back of the scope was used.

3. Dissection using a 5 mm articulated instrument 02'36''

Using a 5mm articulated grasper (Covidien) 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. Gastric fundus mobilization 03'49''

The gastric fundus was mobilized away from the spleen by sequentially dividing the short gastric vessels with the Ligasure® device. The splenic artery was mobilized off the superior aspect of the pancreas.

5. Splenic artery control 05'11''

The artery was ligated but not divided by using an articulated dissector and tying an extracorporeal Roeder’s knot.

6. Division of inferior pole vessels 06'59''

The pancreatic tail was clearly identified and mobilized away from the inferior pole vessels, which were coagulated and divided.

7. Splenic hilum division 08'26''

The splenic hilum was bluntly dissected and at this point one of the 5mm trocars was replaced by a 12mm trocar to accommodate the stapler. One firing of a laparoscopic roticulating linear stapling device carrying a white load was used to transect the splenic hilum. The remaining hilar vessels and medial attachments were divided using the Ligasure® device.

8. Lienorenal ligament dissection 10'45''

The lienorenal ligament and lateral attachments were divided to the upper pole of the spleen. Subcostal placement of the incision permitted the use of straight instruments. The spleen was completely detached. At this point, the 12mm trocar was removed and a 15mm port was inserted.

9. Endo-catch introduction 11'44''

The 15mm port allowed for the insertion of a 15mm Endo-catch bag into the abdomen and the spleen was placed into the bag.

10. Specimen extraction 11'54''

The port was removed, the bag was brought to the skin level, and the spleen was morcellated in a standard fashion. The port was reinserted and a drainage was placed on the splenic bed. The resulting incision was remarkably small and was closed in two layers. The patient was discharged within 24 hours of the procedure.