Laparoendoscopic single site (LESS) splenectomy with a conventional laparoscope and instruments

Background and Objectives: We present 2 cases oflaparoendoscopic single site surgery (LESS) splenectomyperformed with a conventional laparoscope and instruments,and the use of a novel internal retraction device.Methods: One patient underwent LESS splenectomy foridiopathic thrombocytopenia purpura (ITP), and a pediatricpatient with sickle cell disease underwent LESS splenectomyand cholecystectomy. In each case, a 2-cm verticalincision was made within the confines of theumbilical ring, and a SILS port (Covidien, Norwalk CT)inserted. A 5-mm, 30-degree laparoscope and standard5-mm instruments were used. After isolation of the splenichilum, one 5-mm trocar of the SILS port was upsized to12mm, and a laparoscopic stapler was used to divide thesplenic artery and vein. An internal retractor consisting ofa laparoscopic bulldog clamp with a hook attachment wasused to retract the gallbladder, and to secure the specimenretrieval bag during splenic extraction, which eliminatedthe need for a fourth trocar.Results: Total operative time was 160 minutes for theLESS splenectomy, and 216 minutes for the LESS splenectomyand cholecystectomy. Both procedures were successfullycompleted with conventional instrumentationand a SILS port, without the need for additional incisionsor trocars. No complications occurred, and both patientshad an uneventful recovery.Conclusions: LESS splenectomy is a feasible procedurethat can be performed safely. Although articulating instrumentsand laparoscopes may offer advantages, they arenot necessary for performing LESS splenectomy.