title: Single-site multiport combined splenectomy and cholecystectomy with conventional laparoscopic instruments: Case series and review of literature.
abstract: BACKGROUND
  Conventional laparoscopic procedures have been used for splenic diseases and concomitant gallbladder stones, frequently in patients with hereditary spherocytosis since 1990's. The aim of this study is to evaluate the feasibility of single-site surgery with conventional instruments in combined procedures.
  Six consecutive patients who scheduled for combined cholecystectomy and splenectomy because of hereditary spherocytosis or autoimmune hemolytic anemia were included this study. Both procedures were performed via trans-umbilical single-site multiport approach using conventional instruments. All procedures completed successfully without conversion to open surgery or conventional laparoscopic surgery. An additional trocar was required for only one patient. The mean operation time was 190min (150-275min). The mean blood loss was 185ml (70-300ml). Median postoperative hospital stay was two days. No perioperative mortality or major complications occurred in our series. Recurrent anemia, hernia formation or wound infection was not observed during the follow-up period.
  
  
  CONCLUSIONS
  Nowadays, publications are arising about laparoscopic or single site surgery for combined diseases. Surgery for combined diseases has some difficulties owing to the placement of organs and position of the patient during laparoscopic surgery. Single site laparoscopic surgery has been proposed to have better cosmetic outcome, less postoperative pain, greater patient satisfaction and faster recovery compared to standard laparoscopy.
  
  
  CONCLUSIONS
  We consider that single-site multiport laparoscopic approach for combined splenectomy and cholecystectomy is a safe and feasible technique, after gaining enough experience on single site surgery.
authors.affiliation: Istanbul Medeniyet University, Faculty of Medicine, Goztepe Education and Research Hospital, Department of General Surgery, Istanbul, Turkey. Electronic address: draliozemir@hotmail.com.
authors.forename: Ibrahim Ali
authors.initials: IA
authors.lastname: Ozemir
authors.affiliation: Istanbul Medeniyet University, Faculty of Medicine, Goztepe Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Bayraktar
authors.affiliation: Acıbadem University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Bayraktar
authors.affiliation: Istanbul Medeniyet University, Faculty of Medicine, Goztepe Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Tosun
authors.affiliation: Istanbul Medeniyet University, Faculty of Medicine, Goztepe Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.
authors.forename: Cagri
authors.initials: C
authors.lastname: Bilgic
authors.affiliation: Istanbul Medeniyet University, Faculty of Medicine, Goztepe Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Demiral
authors.affiliation: İstanbul Medeniyet University, Göztepe Education and Research Hospital, Department of Hematology, Istanbul, Turkey.
authors.forename: Erman
authors.initials: E
authors.lastname: Ozturk
authors.affiliation: Istanbul Medeniyet University, Faculty of Medicine, Goztepe Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.
authors.forename: Rafet
authors.initials: R
authors.lastname: Yigitbasi
authors.affiliation: Istanbul Medeniyet University, Faculty of Medicine, Goztepe Education and Research Hospital, Department of General Surgery, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Alimoglu
keywords: Cholecystectomy; Minimal invasive surgery; Splenectomy