Application Of Hybrid Transumbilical Single Port Laparoscopic Splenectomy

Objective:To explore the feasibility and safety of hybrid transumbilical single port laparoscopic splenectomy. And discuss the key points of single port laparoscopic splenectomy.Methods:From Nov.2011to Dec.2012, We performed hybrid transumbilical single incision splenectomy in six patients; four cases were idiopathic thrombocytopenic purpura and two cases hereditaryspherocytosis;2cases were male, and4cases were female; the mean age is25-50years old (38.7±9.4years old); the mean BMI is22.45±0.88kg/m2(21.48-23.56kg/m2). They were all confirmed by imageological and hematological examination, matching the indication of splenectomy. The patients were taken supine position, lifting the left side for about5cm. Curved incision of2cm below umbilicus was made the main operating port, single port device was inserted including which self-made glove single port device was used in five cases and SILS accessing device was used in one cases. An assisted5mm Trocar was inserted through an incision2cm below the left subcostal, so as to help revealing or be the observing port, and a tube was drainaged after surgery through it. During the procedure, we used specially-made prolonged and curved instruments addition to the common5mm/10mm30-degree telescope and the traditional laparoendoscopic instruments. Harmonic scalpel was used to dissociate the splenic ligaments. We cut off each branches of the splenic pedicle by Hem-o-lock clips, or cut off the trunk by Endo-GIA. The spleen was put into the specimen bag, and was broken and taken out from umbilical incision. After the surgery, we observed the drainage volume, postoperative complications and length of stay. In the follow-up after discharge, we survey the RBC, HGB and PLT, and estimate the cosmetic result.Results:All the six cases of hybrid transumbilical single port laparoscopic splenectomy were successfully performed without conversion to open or traditional four-trocar splenectomy. The mean operative time was189.2±31.8min (150-225min), the mean blood loss was108.3±58.5ml (50-200ml), and the post-operative hospital stay was7.2±1.2(6-9d). There were no perioperative complications. One patient had fever and turn to normal after taking antipyretics. None was given extra analgesic. During the8.7±3.8months on average(4-14months) follow-up, the patients recovered well. RBC, HGB and PLT are normal. For the umbilical incision was well hidden, no obvious scar, The scar was not obvious2cm below the left subcostal. The total cosmetic result is good.Conclusions:Hybrid transumbilical single port laparoscopic splenectomy is of safety and feasibility, and has the advantage of better cosmetic results compared to the traditional four-port laparoscopic splenectomy. So it can be better accepted by the patient. Although, the procedure is more difficult, the operating time is longer than the latter, the indications should be strict, and we advise that it be performed by experienced minimally invasive surgical doctors in hospitals that have a more mature laparoscopic technique.