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Single-incision laparoscopic splenectomy using the "tug-exposure technique" in adults: results of ten initial cases.

Authors :
Misawa T
Sakamoto T
Ito R
Shiba H
Gocho T
Wakiyama S
Ishida Y
Yanaga K
Misawa, Takeyuki
Sakamoto, Taro
Ito, Ryusuke
Shiba, Hiroaki
Gocho, Takeshi
Wakiyama, Shigeki
Ishida, Yuichi
Yanaga, Katsuhiko
Source :
Surgical Endoscopy & Other Interventional Techniques; Oct2011, Vol. 25 Issue 10, p3222-3227, 6p
Publication Year :
2011

Abstract

<bold>Background: </bold>The application of single-incision laparoscopic surgery (SILS) to splenectomy is still challenging with much room for technical improvement. The purpose of this study was to describe the tug-exposure technique, an innovative technique for performing safe single-incision laparoscopic splenectomy (SILS-Sp).<bold>Methods: </bold>We performed SILS-Sp in ten consecutive adult patients with a variety of pathology requiring total splenectomy. A SILS™ Port with three 5-mm trocars was placed in the umbilicus as a single-access site. A flexible 5-mm laparoscope and an articulating grasper were used in addition to standard laparoscopic equipment. A cloth tape was introduced intraperitoneally to encircle and tug the splenic hilum. Both ends of the tape were extracted through an extra needle hole in the skin. Pulling the tape in appropriate directions provided excellent exposure of the splenic hilum (the tug-exposure technique). Under sufficient tension and exposure by tugging the spleen, a linear stapler was introduced for stapling and dividing the splenic hilum and the splenic artery and vein. The spleen was extracted through the umbilical wound within a retrieval bag. The umbilical wound was closed with subcutaneous sutures.<bold>Results: </bold>The tug-exposure technique was successfully used in all patients and markedly improved the exposure of the splenic hilum during SILS-Sp. The median intraoperative blood loss was 15 (range 0-1,000) ml. Only one patient (10%) required conversion to open surgery. Median operative time was 230 (range, 150-378) min, the median extracted spleen weight was 260 (range, 100-580) g, and the median postoperative hospital stay was 7 (range, 4-9) days. All patients were discharged uneventfully. The umbilical incision was nearly invisible at the 1-month follow-up.<bold>Conclusions: </bold>The tug-exposure technique is an innovative technique that enables easy and safe SILS splenectomy by experienced surgeons. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
18666817
Volume :
25
Issue :
10
Database :
Complementary Index
Journal :
Surgical Endoscopy & Other Interventional Techniques
Publication Type :
Academic Journal
Accession number :
104582874
Full Text :
https://doi.org/10.1007/s00464-011-1697-y