title: Feasibility and safety of single-incision laparoscopic splenectomy: a systematic review.
abstract: OBJECTIVE
  The aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic splenectomy (SILS-Sp).
  
  
  METHODS
  We conducted a systemic review of literature between 2009 and 2012 to retrieve all relevant articles.
  
  
  RESULTS
  A total of 29 studies with 105 patients undergoing SILS-Sp were reviewed. Fifteen studies used a commercially available single-port device. The range of body mass index was 14.7-41.4 kg/m(2). Six studies described combined operations including cholecystectomy (n = 8), mesh-pexy (n = 1), and pericardial devascularizaion (n = 1). The ranges of operative times and estimated blood losses were 28-420 min and 0-350 mL, respectively. Of 105 patients, three patients (2.9%) required additional ports, two patients (1.9%) were converted to open, and three patients (2.9%) to conventional multiport laparoscopic splenectomy (overall conversion rate, 4.8%). Postoperative bleeding occurred in two patients (1.9%) who both required reoperation. Overall mortality was 0% (0/105). The length of postoperative stay varied across reports (1-11 d). Among four comparative studies, one showed greater estimated blood loss and lower numeric pain rating scale score in the SILS-Sp group than in the multiport laparoscopic splenectomy group (206.25 ± 142.45 versus 111.11 ± 99.58 mL) and (3.81 ± 0.91 versus 4.56 ± 1.29), respectively. Another comparative study showed that SILS-Sp was associated with a shorter operative time (92.5 versus 172 min; P = 0.003), lower conversion rate, equivalent length of hospital stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements.
  
  
  CONCLUSIONS
  In early series of highly selected patients, SILS-Sp appears to be feasible and safe when performed by experienced laparoscopic surgeons. However, as an emerging operation, publication bias is a factor that should be considered before we can draw an objective conclusion.
authors.affiliation: Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, Shenyang City, Liaoning Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Fan
authors.forename: Shuo-Dong
authors.initials: SD
authors.lastname: Wu
authors.forename: Jing
authors.initials: J
authors.lastname: Kong
authors.forename: Yang
authors.initials: Y
authors.lastname: Su
authors.forename: Yu
authors.initials: Y
authors.lastname: Tian
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: Efficacy; Multiport laparoscopic splenectomy; Safety; Single-incision laparoscopic surgery; Splenectomy; Systematic review