Service of Surgery, Hospital de Sant Pau, UAB, Mas Casanovas 90, Barcelona, Spain.
Surg Endosc. 2010 Sep;24(9):2236-40. doi: 10.1007/s00464-010-0940-2. Epub 2010 Feb 23.
There is a current trend to reduce the invasiveness of minimally invasive procedures, and the single-incision laparoscopic approach (SILS) has been proposed for several intra-abdominal surgical interventions. The spleen poses specific problems for techniques, such as SILS, due to its volume and texture, and little clinical information is available on the topic. We describe our initial experience using SILS for the management of splenic diseases.
Between December 2008 and September 2009, we attempted SILS in eight patients: four men and four women with a median age of 44 (range, 26-73) years, and body mass index of 24.5 (range, 18-31). Preoperative diagnosis was malignancy (n = 3), ITP (n = 1), HIV-related hypersplenism (n = 1), spherocytosis (n = 1), and splenic cyst (n = 2). SILS was attempted transumbilically in four cases and through a 15-mm subcostal single incision in the other four. As entry port we used either three trocars (one of 12 mm and two of 5 mm) inserted through the single-site incision or the umbilicus, or a multiport (Triport, Olympus) device. Instrumentation used consisted of curved instruments, a flexible-tip 10-mm scope, and the harmonic scalpel. Visualization of the spleen and standard dissection of attachments was accomplished, and splenectomy was completed by stapling of the splenic hilum. The spleen was extracted through the single-site incision. In two cases, unroofing of a splenic cyst was performed transumbilically.
The SILS procedure was successful in six of the eight patients (75%). Conversion to conventional laparoscopic splenectomy (LS) was required in two patients due to adhesions and spleen size. Median operative time was 97 (range, 60-150) min. There were no postoperative complications, and median stay was 4 (range, 2-5) days. Median spleen weight was 485 (range, 340-590) g.
SILS access can be safely used for operative visualization, hilum transection, and spleen removal, further reducing parietal wall trauma. The definitive clinical, esthetic, and functional advantages require further analysis.
目前微创手术的趋势是减少其侵入性，单切口腹腔镜（SILS）技术已被提出用于多种腹腔内手术干预。由于脾脏的体积和质地，该技术对脾脏手术提出了特殊的挑战，关于这方面的临床信息很少。我们介绍了我们在使用 SILS 治疗脾脏疾病方面的初步经验。
在 2008 年 12 月至 2009 年 9 月期间，我们尝试对 8 例患者采用 SILS：4 例男性，4 例女性，中位年龄 44（范围 26-73）岁，体重指数 24.5（范围 18-31）。术前诊断为恶性肿瘤（n=3）、特发性血小板减少性紫癜（n=1）、HIV 相关性脾功能亢进（n=1）、球形红细胞增多症（n=1）和脾囊肿（n=2）。4 例经脐部尝试 SILS，4 例经 15mm 肋缘下单切口。入口端口我们使用了三个套管针（一个 12mm 和两个 5mm）插入单点切口或脐部，或使用多端口（Olympus 的 Triport）设备。使用的器械包括弯曲器械、10mm 柔性尖端的腹腔镜和超声刀。完成脾脏的可视化和标准的附着分离后，通过夹闭脾门来完成脾切除术。脾通过单点切口取出。在 2 例患者中，经脐部进行脾囊肿去顶术。
8 例患者中有 6 例（75%）成功完成 SILS 手术。由于粘连和脾脏大小，有 2 例患者需要转为传统腹腔镜脾切除术（LS）。中位手术时间为 97（范围 60-150）min。术后无并发症，中位住院时间为 4（范围 2-5）天。中位脾脏重量为 485（范围 340-590）g。
SILS 入路可安全用于手术可视化、门脉横断和脾脏切除，进一步减少了壁层创伤。确切的临床、美容和功能优势需要进一步分析。
