Palermo Mariano, Blanco Luis, Acquafresca Pablo, Menendez Jose, Garcia Rafael
Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina.
Arq Bras Cir Dig. 2015 Nov-Dec;28(4):282-5. doi: 10.1590/S0102-6720201500040016.
Delaitre and Maignien performed the first successful laparoscopic splenectomy in 1991. After that, laparoscopic splenectomy has become one of the most frequently performed laparoscopic solid organ procedures.
To demonstrate the surgical techique of laparoscopic splenetomy with reduced portals.
A reduce port laparoscopic splenectomy was performed by using a 10 mm and two 5 mm trocars. To entered the abdomen a trans-umbilical open technique was done and a 10 mm trocar was placed. A subcostal 5 mm trocar was placed under direct vision at the level of the anterior axillary line and another 5 mm port was inserted at the mid-epigastric region. Once it was completely dissected and freed from all of its attachments the hilum, splenic artery and vein, was clipped with hem-o-lock and divided with scissors. Then an endobag was used to retrieve the spleen after being morcellated trough the umbilical incision.
This technique was used in a 15 years old female with epigastric and left upper quadrant pain. An abdominal ultrasound demonstrated a giant cyst located in the spleen. Laboratory tests findings were normal. The CT scan was also done, and showed a giant cyst, which squeeze the stomach. The patient tolerated well the procedure, with an unremarkable postoperative. She was discharge home 72 h after the surgery.
The use of reduce port minimizes abdominal trauma and has the hypothetical advantages of shorter postoperative stay, greater pain control, and better cosmesis. Laparoscopic splenectomy for giant cysts by using reduce port trocars is safe and feasible and less invasive.
1991年，德莱特尔和迈尼安成功实施了首例腹腔镜脾切除术。此后，腹腔镜脾切除术已成为最常施行的腹腔镜实性器官手术之一。
展示减少切口的腹腔镜脾切除术的手术技术。
采用一个10毫米和两个5毫米的套管针进行减少切口的腹腔镜脾切除术。通过经脐开放技术进入腹腔，置入一个10毫米的套管针。在腋前线水平直视下置入一个肋下5毫米的套管针，并在中上腹区域插入另一个5毫米的端口。一旦脾脏完全游离并切断所有附着处，即使用血管夹夹闭脾门、脾动脉和静脉，并用剪刀切断。然后使用一个内袋，将脾脏切碎后经脐部切口取出。
该技术应用于一名15岁的女性患者，她有上腹部和左上腹疼痛。腹部超声显示脾脏有一个巨大囊肿。实验室检查结果正常。还进行了CT扫描，显示有一个巨大囊肿，压迫胃部。患者对手术耐受良好，术后情况平稳。术后72小时出院回家。
使用减少切口的方法可将腹部创伤降至最低，理论上具有术后住院时间更短、疼痛控制更好和美容效果更佳的优点。使用减少切口的套管针进行腹腔镜巨大囊肿脾切除术是安全可行的，且创伤较小。
