Single-Incision Laparoscopic Splenectomy Using the Suture Suspension Technique for Splenomegaly in Children with Hereditary Spherocytosis

Abstract

Background: With increasing laparoscopic surgery experience and improved new vessel-sealing equipment, single-incision laparoscopic surgery (SILS) for splenectomy has emerged as an alternative to multiport laparoscopy, but the application of SILS for splenomegaly is still challenging due to technical difficulties. The aim of this study was to describe the suture suspension technique contributing to SILS for hereditary spherocytosis (HS).

Materials and methods: A retrospective review was conducted to evaluate all SILS for splenomegaly performed by a single surgeon. On preoperative ultrasonography, the spleen size index ranged from 0.67 to 0.82. An umbilical incision was used for the placement of a multichannel single port. To provide excellent exposure of the splenic hilum, a needle with a 1-0 suture was percutaneously introduced from the left hypochondriac region and then penetrated out the anterior chest wall for suspending the enlarged spleen. Dissection was facilitated by the use of a 5-mm curved reusable grasper and a 5-mm Harmonic(®) scalpel (Ethicon Endo-Surgery, Cincinnati, OH), and the splenic vessels were ligated with 5-mm Weck(®) Hem-o-lok(®) clips (Teleflex(®), Morrisville, NC). The resected spleen was placed in an endosurgical bag, morcellated, and removed from the abdomen via the umbilical incision.

Results: Nine children underwent SILS during the study period without conversion to open procedures or requiring additional ports. The suture suspension technique was successfully used and markedly improved the exposure of the splenic hilum. The operative time was 122.6 ± 31.2 minutes, and the extracted spleen weight was 562 ± 74.5 g (range, 420-1260 g). No intraoperative or postoperative complications were recorded. The umbilical incision healed well with a satisfactory cosmetic effect.

Conclusions: Our outcome shows the suture suspension enables safe and feasible usage of SILS for the management of splenomegaly in children with HS. More experience is needed to assess advantages and disadvantages compared with the standard laparoscopic approach.