Single access transumbilical laparoscopic splenectomy using curved and reusable instruments

This patient is a 23-year-old female who is candidate for elective splenectomy for idiopathic thrombocytopenic purpura (ITP). A single access transumbilical laparoscopic splenectomy using curved and reusable instruments is presented. Thanks to the special shape of these instruments, there is no conflict, no jamming inside the abdomen or outside the abdomen.

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Single access transumbilical laparoscopic splenectomy using curved and reusable instruments

Authors

G Dapri, J Himpens, GB Cadière

Abstract

This patient is a 23-year-old female who is candidate for elective splenectomy for idiopathic thrombocytopenic purpura (ITP). A single access transumbilical laparoscopic splenectomy using curved and reusable instruments is presented. Thanks to the special shape of these instruments, there is no conflict, no jamming inside the abdomen or outside the abdomen.

Classification

single port, contribution

Keywords

Single access, transumbilical, laparoscopic splenectomy, curved reusable instruments

Media type

Surgical video

Duration

05'50''

Publication

2011-02

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E-publication

WeBSurg.com, Feb 2011;11(02).
URL: http://www.websurg.com/doi-vd01en3121.htm

Single access transumbilical laparoscopic splenectomy using curved and reusable instruments

1. Introduction 00'19''

This patient is a 23-year-old female who is candidate for elective splenectomy for idiopathic thrombocytopenic purpura.

2. Umbilical access 00'30''

The incision is performed under the umbilicus, the fascia is freed and an incision is made in the fascia. A purse-string is applied and the opening is used for the insertion of an 11mm trocar, which will harbor a 30-degree-angled optical system. Since we are trying to perform a single incision splenectomy, we use particular tools —namely bi-curved graspers—, which are inserted just outside the purse-string through a separate fascial incision. The hook has a special shape as well. It is singly bent and is introduced this time within the purse-string. Thanks to the special shape of both instruments, there is no conflict, no jamming inside the abdomen or outside the abdomen.

3. Spleen lower pole dissection 01'51''

Dissection is started at the lower pole of the spleen by severance of the splenocolic ligament. Incision of the peritoneum is taken cephalad and the gastrosplenic ligament is taken down. By doing this, the space between the stomach and the spleen opens up. Still there is no conflict with instruments either inside or outside the abdomen.

4. Division of short gastric vessels 02'31''

The short gastric vessels are ligated with cautery.

5. Division of splenic artery 02'38''

The splenic artery is spotted and is isolated by using dissection with the coagulating hook. The artery is skeletonized and is ligated by the use of 5mm clips. As soon as the artery is ligated, the spleen becomes darkened. The scissors are inserted. They also are specially shaped, with a single bend, allowing again not to be in conflict with the other instruments.

6. Division of splenic vein 03'53''

The dissection is continued with the coagulating hook and the splenic vein is now dissected free, doubly clipped and transected.

7. Completion of dissection 04'27''

The spleen is now entirely devascularized and the attachments that remain, located especially dorsally, are severed progressively from distal to proximal, while the double-curved grasper is meeting the spleen in a ventral direction. The avascular attachments between the peritoneum and the spleen are taken down progressively.

8. Specimen extraction 05'08''

A plastic bag is introduced through the 11mm trocar and the spleen is placed inside the bag. The bag is pulled through the umbilical incision, at least partially, and the spleen itself is now morcellated using a special section device and Kelly graspers. The spleen is removed piecemeal, and eventually the entire bag is removed. The final incision appears to be exactly 16mm in size.