title: Laparoendoscopic single site (LESS) splenectomy with a conventional laparoscope and instruments.
abstract: OBJECTIVE
  We present 2 cases of laparoendoscopic single site surgery (LESS) splenectomy performed with a conventional laparoscope and instruments, and the use of a novel internal retraction device.
  
  
  METHODS
  One patient underwent LESS splenectomy for  idiopathic thrombocytopenia purpura (ITP), and a pediatric patient with sickle cell disease underwent LESS splenectomy and cholecystectomy. In each case, a 2-cm vertical incision was made within the confines of the umbilical ring, and a SILS port (Covidien, Norwalk CT) inserted. A 5-mm, 30-degree  laparoscope and standard 5-mm instruments were used. After isolation of the splenic hilum, one 5-mm trocar of the SILS port was upsized to 12mm, and a laparoscopic stapler was used to divide the splenic artery and vein. An internal retractor consisting of a laparoscopic bulldog clamp with  a hook attachment was used to retract the gallbladder, and to secure the specimen retrieval bag during splenic extraction, which eliminated the need for a fourth trocar.
  
  
  RESULTS
  Total operative time was 160 minutes for the LESS splenectomy, and 216 minutes for the LESS splenectomy  and cholecystectomy. Both procedures were successfully completed with conventional instrumentation and a SILS port, without the need for additional incisions or trocars. No complications occurred, and both patients had an uneventful recovery.
  
  
  CONCLUSIONS
  LESS splenectomy is a feasible  procedure that can be performed safely. Although articulating instruments and laparoscopes may offer advantages, they are not necessary for performing LESS splenectomy.
authors: Division of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
authors: Modesto J
authors: MJ
authors: Colon
authors: Dana
authors: D
authors: Telem
authors: Edward
authors: E
authors: Chan
authors: Peter
authors: P
authors: Midulla
authors: Celia
authors: C
authors: Divino
authors: Edward H
authors: EH
authors: Chin
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic; D004867:Equipment Design; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D013156:Splenectomy / Q000295:instrumentation* / Q000379:methods*