Laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen since its first description in 1991. Indications for LS have rapidly increased and LS is now considered the standard approach for the treatment of benign and malignant hematologic disorders, especially by young patients who find small scars cosmetically preferable.
Single incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. In this video, we present an original technique of SILS splenectomy in a woman diagnosed with idiopathic thrombocytopenia. A 2.2cm left subcostal incision lateral to the rectus muscles was used for the placement of the single port device with conventional laparoscopic instruments, using a Veress needle covered by a small sponge to lift the spleen that was removed through the same incision.

This patient is a 23-year-old female who is candidate for elective splenectomy for idiopathic thrombocytopenic purpura (ITP). A single access transumbilical laparoscopic splenectomy using curved and reusable instruments is presented. Thanks to the special shape of these instruments, there is no conflict, no jamming inside the abdomen or outside the abdomen.

This video demonstrates a laparoscopic single port splenectomy in a 27-year-old woman with medically refractory idiopathic thrombocytopenic purpura (ITP). The procedure was performed using a multi-instrument flexible single incision port, SILS port (Covidien), which was inserted through a 2.5cm left upper quadrant incision. A standard splenectomy was performed through this port by using the Ligasure® device (Covidien), a laparoscopic linear stapling device and articulated instruments. The procedure time was just over 2 hours. The patient was discharged within 24 hours of the procedure.

In this lecture, Professor Zygmunt Krukowsky presents the characteristics of single port surgery and shows the operative technique of single port adrenalectomy and splenectomy.

A technique for single port splenectomy in a normal sized spleen and using a single 2cm subcostal incision is demonstrated. This approach was chosen to allow the use of a straight (non-articulated) 5mm Ligasure device. This was used to divide the gastrosplenic ligament and short gastric vessels, to seal in continuity the splenic artery, divide the lienorenal ligament and seal and divide the splenic hilar vessels. The SILS port easily accommodated a 15mm port for passage of large retrieval bag without excessive distraction of the incision.

Laparoscopic splenectomy (LS) is the gold standard approach for normal spleens. Conventional LS requires 3 to 5 large bore trocars and enlargement of one trocar for bag insertion and spleen morcellation. There is a trend to reduce invasiveness of minimally invasive procedures with NOTES, hybrid NOTES and single incision surgery, but it has not yet been applied to the spleen. This video demonstrates the technical details to perform single port access laparoscopic splenectomy.