Splenectomy using a completely needlescopic procedure: report of three cases

Abstract

Background and purpose: Needlescopic instruments are being used in various fields of endoscopic surgery. We evaluated the safety and efficacy of laparoscopic splenectomy using a needlescope.

Patients and methods: This procedure was performed in three patients, two women and one man, having idiopathic thrombocytopenic purpura that had not responded to medical treatment. Four ports (one 12 mm and three 2 mm in diameter) were introduced into the left upper quadrant. A 2-mm needlescope was used throughout the procedure. The spleen was divided from the splenocolic, splenophrenic, and splenorenal ligaments posterior to the splenic hilum. The splenic hilar and short gastric vessels were divided simultaneously using a linear stapler. The resected spleen was morcellated via the 12-mm port.

Results: The mean operation time was 167 minutes, and the mean estimated blood loss was 70 mL. No postoperative analgesia was needed by any of the patients, and there were no perioperative complications. The 2-mm postoperative scars were virtually invisible.

Conclusion: Needlescopic splenectomy for idiopathic thrombocytopenic purpura is feasible and safe with less postoperative pain and a superior cosmetic result compared with conventional laparoscopic splenectomy.