title: Single-access transumbilical laparoscopic splenectomy using curved reusable instruments.
abstract: BACKGROUND
  The authors report a single-access transumbilical laparoscopic splenectomy (SATLS) performed with curved reusable instruments.
  
  
  METHODS
  A 23-year-old female consulted for steroid-resistant idiopathic thrombocytopenic purpura and clinical evidence of secondary Cushing syndrome. Preoperative workup showed a normal-sized spleen and thrombocytopenia. The umbilicus was incised and a purse-string suture was applied. A reusable 11-mm trocar was inserted for a 10-mm, 30° angled scope. Curved reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany) were advanced without trocars transumbilically. After opening the splenocolic and gastrosplenic ligaments, the main splenic artery and vein were dissected off at the level of the hilum, clipped with 5-mm clips introduced transumbilically, and sectioned. Posterior splenic attachments were freed at the hilum cranially and caudally. The spleen was finally retrieved transumbilically in a plastic bag.
  
  
  RESULTS
  Addition of supplementary trocars or incisions was not necessary. Operative time was 180 min and final umbilical scar 16 mm. The patient was discharged on postoperative day 3, and after 6 months she was doing well.
  
  
  CONCLUSIONS
  SATLS was feasible and safe to be performed using curved reusable instruments. The curves of the instruments permitted the surgeon to work in an ergonomic position, without the instruments clashing thanks to the obtained triangulation. Since only reusable instruments were used, the cost of SATLS remained similar to that of standard laparoscopy.
authors.affiliation: Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.net
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.forename: Dominique
authors.initials: D
authors.lastname: Bron
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Casali
authors.forename: Pietro
authors.initials: P
authors.lastname: Carnevali
authors.forename: Pavlos
authors.initials: P
authors.lastname: Koustas
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
mesh_terms: D003480:Cushing Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D011696:Purpura, Thrombocytopenic / Q000601:surgery*; D013156:Splenectomy / Q000295:instrumentation*; D013525:Surgical Instruments; D014472:Umbilicus / Q000601:surgery*; D055815:Young Adult