Colon Modesto J, Telem Dana, Chan Edward, Midulla Peter, Divino Celia, Chin Edward H
Division of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
JSLS. 2011 Jul-Sep;15(3):384-6. doi: 10.4293/108680811X13125733356918.
We present 2 cases of laparoendoscopic single site surgery (LESS) splenectomy performed with a conventional laparoscope and instruments, and the use of a novel internal retraction device.
One patient underwent LESS splenectomy for idiopathic thrombocytopenia purpura (ITP), and a pediatric patient with sickle cell disease underwent LESS splenectomy and cholecystectomy. In each case, a 2-cm vertical incision was made within the confines of the umbilical ring, and a SILS port (Covidien, Norwalk CT) inserted. A 5-mm, 30-degree laparoscope and standard 5-mm instruments were used. After isolation of the splenic hilum, one 5-mm trocar of the SILS port was upsized to 12mm, and a laparoscopic stapler was used to divide the splenic artery and vein. An internal retractor consisting of a laparoscopic bulldog clamp with a hook attachment was used to retract the gallbladder, and to secure the specimen retrieval bag during splenic extraction, which eliminated the need for a fourth trocar.
Total operative time was 160 minutes for the LESS splenectomy, and 216 minutes for the LESS splenectomy and cholecystectomy. Both procedures were successfully completed with conventional instrumentation and a SILS port, without the need for additional incisions or trocars. No complications occurred, and both patients had an uneventful recovery.
LESS splenectomy is a feasible procedure that can be performed safely. Although articulating instruments and laparoscopes may offer advantages, they are not necessary for performing LESS splenectomy.
我们展示了2例使用传统腹腔镜及器械并采用新型内部牵开装置实施的单孔腹腔镜脾切除术（LESS）。
1例特发性血小板减少性紫癜（ITP）患者接受了LESS脾切除术，1例镰状细胞病患儿接受了LESS脾切除术及胆囊切除术。每例患者均在脐环范围内做一个2cm的垂直切口，插入一个单孔腹腔镜手术端口（柯惠医疗，美国康涅狄格州诺沃克）。使用5mm、30°的腹腔镜及标准5mm器械。在游离脾门后，将单孔腹腔镜手术端口的一个5mm套管扩大至12mm，使用腹腔镜吻合器离断脾动静脉。一种由带钩附件的腹腔镜弹簧夹组成的内部牵开器用于牵开胆囊，并在取出脾脏时固定标本回收袋，从而无需第四个套管。
LESS脾切除术的总手术时间为160分钟，LESS脾切除术及胆囊切除术的总手术时间为216分钟。两种手术均使用传统器械及单孔腹腔镜手术端口成功完成，无需额外切口或套管。未发生并发症，两名患者均顺利康复。
LESS脾切除术是一种可行的手术，可安全实施。尽管可弯曲器械及腹腔镜可能具有优势，但它们并非LESS脾切除术所必需。
