Li Suolin, Li Meng, Xu Weili, Sun Chi, Liu Lin
Department of Pediatric Surgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
J Laparoendosc Adv Surg Tech A. 2015 Sep;25(9):770-4. doi: 10.1089/lap.2014.0375. Epub 2015 May 6.
With increasing laparoscopic surgery experience and improved new vessel-sealing equipment, single-incision laparoscopic surgery (SILS) for splenectomy has emerged as an alternative to multiport laparoscopy, but the application of SILS for splenomegaly is still challenging due to technical difficulties. The aim of this study was to describe the suture suspension technique contributing to SILS for hereditary spherocytosis (HS).
A retrospective review was conducted to evaluate all SILS for splenomegaly performed by a single surgeon. On preoperative ultrasonography, the spleen size index ranged from 0.67 to 0.82. An umbilical incision was used for the placement of a multichannel single port. To provide excellent exposure of the splenic hilum, a needle with a 1-0 suture was percutaneously introduced from the left hypochondriac region and then penetrated out the anterior chest wall for suspending the enlarged spleen. Dissection was facilitated by the use of a 5-mm curved reusable grasper and a 5-mm Harmonic(®) scalpel (Ethicon Endo-Surgery, Cincinnati, OH), and the splenic vessels were ligated with 5-mm Weck(®) Hem-o-lok(®) clips (Teleflex(®), Morrisville, NC). The resected spleen was placed in an endosurgical bag, morcellated, and removed from the abdomen via the umbilical incision.
Nine children underwent SILS during the study period without conversion to open procedures or requiring additional ports. The suture suspension technique was successfully used and markedly improved the exposure of the splenic hilum. The operative time was 122.6 ± 31.2 minutes, and the extracted spleen weight was 562 ± 74.5 g (range, 420-1260 g). No intraoperative or postoperative complications were recorded. The umbilical incision healed well with a satisfactory cosmetic effect.
Our outcome shows the suture suspension enables safe and feasible usage of SILS for the management of splenomegaly in children with HS. More experience is needed to assess advantages and disadvantages compared with the standard laparoscopic approach.
随着腹腔镜手术经验的增加和新型血管封闭设备的改进，单孔腹腔镜脾切除术（SILS）已成为多孔腹腔镜手术的一种替代方法，但由于技术困难，SILS在脾肿大治疗中的应用仍具有挑战性。本研究的目的是描述有助于SILS治疗遗传性球形红细胞增多症（HS）的缝合悬吊技术。
对由单一外科医生实施的所有针对脾肿大的SILS进行回顾性评估。术前超声检查显示，脾脏大小指数在0.67至0.82之间。采用脐部切口放置多通道单孔端口。为了充分暴露脾门，用一根带有1-0缝线的针经皮从左季肋区插入，然后从前胸壁穿出，以悬吊肿大的脾脏。使用5毫米可重复使用的弯曲抓钳和5毫米超声刀（Ethicon Endo-Surgery公司，俄亥俄州辛辛那提）便于进行解剖，脾血管用5毫米Weck Hem-o-lok夹（Teleflex公司，北卡罗来纳州莫里斯维尔）结扎。切除的脾脏放入内镜手术袋中，切碎后经脐部切口从腹部取出。
在研究期间，9名儿童接受了SILS手术，无一例转为开放手术或需要增加端口。成功应用了缝合悬吊技术，显著改善了脾门的暴露。手术时间为122.6±31.2分钟，切除脾脏重量为562±74.5克（范围为420-1260克）。未记录到术中或术后并发症。脐部切口愈合良好，美容效果满意。
我们的结果表明，缝合悬吊技术使SILS安全可行地用于治疗HS患儿的脾肿大。与标准腹腔镜手术方法相比，还需要更多经验来评估其优缺点。
