Single incision versus reduced port splenectomy--searching for the best alternative to conventional laparoscopic splenectomy.
BACKGROUND
Laparoscopic splenectomy (LS) is a well accepted approach for the treatment of multiple hematologic diseases. Single port access splenectomy (SPAS) emphasizes the concept of surgery through one small incision. The reduced port access splenectomy (RPAS) entails the use of fewer trocars of smaller sizes. The aim of this study was to compare the clinical outcomes after LS, SPAS, and RPAS, and to analyze the aesthetic result and patient satisfaction.


METHODS
We included patients who underwent LS (group 1, n = 15), SPAS (group 2, n = 8), and RPAS (group 3, n = 10) between June 2008 and February 2012, whose final spleen weight was less of 500 g. The outcome parameters analyzed were operative time, need of additional trocars, blood loss, blood transfusion, weight of the spleen, postoperative complications, and duration of hospital stay. To evaluate the cosmetic result, patients were asked to take the Body Image Questionnaire.


RESULTS
Patients in group 3 were younger than group 1. Operative time was significantly longer in group 2 compared to groups 1 and 3 (83 ± 19 vs. 131 ± 43 vs. 81 ± 22 min, p = 0.01). There was no need to convert to open surgery in any group, nor were there differences in intra- or postoperative outcome. There were no differences between the groups in relation to the analgesic requirements. Twenty-two out of the 33 patients answered the questionnaire. There was a significant advantage in group 2 and 3 in the body image index with respect to group 1. There were no differences between groups 2 and 3 (7.3 ± 2.8 vs. 5.8 ± 1.3 vs. 5.1 ± 0.4, p < 0.02).


CONCLUSIONS
RPAS is a good alternative to LS and SPAS. It improves the aesthetic results as compared to LS, whereas minimizes the technical challenges faced with SPAS.
Department of Surgery, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 4th floor, 08041 Barcelona, Spain. juliocesar1701@hotmail.com
Julio Lopez
JL
Monclova
Eduardo M
EM
Targarona
Pablo
P
Vidal
Yerald
Y
Peraza
Francisco
F
Garcia
Carlos Rodriguez
CR
Otero
Luis
L
Pallares
Carmen
C
Balague
Manuel
M
Trias
D000700:Analgesics / Q000627:therapeutic use; D000744:Anemia, Hemolytic, Autoimmune / Q000473:pathology / Q000523:psychology / Q000601:surgery; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001828:Body Image; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000523:psychology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000473:pathology / Q000523:psychology / Q000601:surgery; D013156:Splenectomy / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000700:Analgesics