title: First experience with single incision laparoscopic surgery in Slovakia: concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis.
abstract: OBJECTIVE
  Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis.
  
  
  METHODS
  A 2-3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed.
  
  
  RESULTS
  Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and despite the small number of cases in the world, we consider the combined laparoscopic approach safe and effective for the treatment of hereditary spherocytosis.
  
  
  CONCLUSIONS
  According to actually published guidelines, the laparoscopic approach to concomitant splenectomy and cholecystectomy is recommended, but it depends on the availability of appropriately trained surgeons and suitable equipment.
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine and Children's Medical Hospital, Comenius University in Bratislava, Limbova 1, 833 40 Bratislava, Slovak Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cingel
authors.forename: Lenka
authors.initials: L
authors.lastname: Zabojnikova
authors.forename: Patricia
authors.initials: P
authors.lastname: Kurucova
authors.forename: Ivan
authors.initials: I
authors.lastname: Varga
mesh_terms: D002648:Child; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D018154:Slovakia; D013103:Spherocytosis, Hereditary / Q000601:surgery*; D013156:Splenectomy