title: Single incision approach for splenic diseases: a preliminary report on a series of 8 cases.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service of Surgery, Hospital de Sant Pau, UAB, Mas Casanovas 90, Barcelona, Spain. etargarona@santpau.cat
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Targarona
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Pallares
authors.forename: Carmen
authors.initials: C
authors.lastname: Balague
authors.forename: Carlos Rodríguez
authors.initials: CR
authors.lastname: Luppi
authors.forename: Franco
authors.initials: F
authors.lastname: Marinello
authors.forename: Pilar
authors.initials: P
authors.lastname: Hernández
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez
authors.forename: Manuel
authors.initials: M
authors.lastname: Trias
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery*; D016896:Treatment Outcome