Single incision versus reduced port splenectomy—searching for the best alternative to conventional laparoscopic splenectomy

Monclova, Julio Lopez; Targarona, Eduardo M.; Vidal, Pablo; Peraza, Yerald; García, Francisco César Becerra; Otero, Carlos Rodriguez; Pallares, Luis; Balagué, Carmen; Trías, Manuel

doi:10.1007/s00464-012-2530-y

Cited by 26 publications

(30 citation statements)

References 21 publications

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“…No patients were converted to OS in any group, but three patients required additional trocars to finish the SPAS. RPAS had an operative time comparable to that of LS and significantly shorter than the SPAS (16). The results of this unique study are insufficient to establish any evidence of superiority of RPAS and SPAS over LS, apart from the better postoperative comfort and cosmetic result.…”

Section: Resultsmentioning

confidence: 71%

“…Studies with shorter durations of follow-up had significantly higher relapse rates than studies with longer follow-up. It was concluded that splenectomy may have higher initial relapse rates in the first 2 years after surgery, (20) Splenic bed collection, peripancreatic fluid collections, 0% 6.25% 0% bleeding from the splenic artery stump, symptomatic PVT Nobili et al (17) Hemoperitoneum 0% 10% 0% Chen et al (9) Bleeding, pneumonia, subphrenic fluid collection, left pleural effusion 0% 11% 0% Wu et al (25) Subphrenic hematoma, bleeding 0% 0% 0% Zheng et al (27) Subphrenic abscess, bleeding 0.6% 8.4% 0% Zheng et al (26) N/A N/A N/A N/A Wu et al (24) Subphrenic hematoma, bleeding 0% 0% 0% Al-Mulhim (7) Acute chest syndrome, left subphrenic hematoma, left pleural effusion 0% 8.4% 0% Patel et al (18) PE, DVT, pneumonia, MI 0% 10% 0% Corcione et al (10) Fluid collections in the splenic fossa, subphrenic 0.3% 13% 1% abscesses, bleeding, intestinal ischemia Fraser et al (11) PVT, sepsis, bleeding, intestinal ischemia 3.9% 21.1% N/A Monclova et al (16) Bleeding from a vessel of the greater omentum, 0% 15.6% 3% subphrenic fluid collection, pancreatic fistula. Li et al (13) Wound complications, sepsis, subhepatic abscess, respiratory complications 0% 6.67% 0% Marte et al (14) Bleeding, OPSI 2.08% 8.8-35.7% 0% Wang et al (23) Bleeding, PVT 0% 6.9% 6.9% Vecchio et al (6) Conversion to open surgery was required in one patient because of 0% 0% 0% lack of anatomic definition of Calot triangle's structures.…”

Section: Critical Evaluationmentioning

confidence: 99%

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Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Moris

Dimitriou

Grınıatsos

2017

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Section: Resultsmentioning

confidence: 71%

Section: Critical Evaluationmentioning

confidence: 99%

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Moris

Dimitriou

Grınıatsos

2017

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“…After the literature search two prospective [122, 123] and four retrospective comparative studies [124–127] have been selected for review, in which SIES splenectomy is compared to standard (or reduced port) laparoscopic splenectomy (LS). No randomized clinical trials have been published on this topic, which may be related to the fact that elective splenectomy is a rarely performed operation.…”

Section: Resultsmentioning

confidence: 99%

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

et al. 2019

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BackgroundLaparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.MethodsAn expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria.ResultsIn general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies.ConclusionsConsidering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.

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“…Key words: Cholecystectomy; laparoscopy; single-incision laparoscopic surgery (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

mentioning

confidence: 99%

Extraumbilical Single-Incision Laparoscopic Cholecystectomy with Standard Laparoscopic Instruments

Oruç

Uğurlu

2013

Scand J Surg

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Background and Aim: Single-incision laparoscopic surgery is a rapidly progressing field as it combines some advantages such as cosmesis and less incisional pain. However, it also has some disadvantages such as limitation of movement and clashing of the hand instruments, which increase the complexity and technical challenges of the operation. In this study, we describe a pilot trial of single-incision laparoscopic cholecystectomy through a paramedian access site.Material and Methods: A total of 25 patients underwent single-incision laparoscopic cholecystectomy with this method. Acute cases with empyema and patients with history of previous abdominal surgery were excluded. Single-incision is established on the right upper quadrant, right latero-superior of the umbilicus, so that trocar sites and projection of the gallbladder on the abdominal wall are on the same vertical line. Standard laparoscopic instruments were placed into the abdominal cavity providing triangulation. Once the laparoscope, grasper, and dissector are in place, the overall procedures are similar to the standard laparoscopic cholecystectomy.Results: Single-incision laparoscopic cholecystectomy through an extraumbilical access site was successfully completed in all 25 patients without conversion to open surgery. Additional skin incisions and trocar access were required only in two patients. The mean operative time was 39.3 min (range: 20-75 min). The mean body mass index was 27.2. Postoperative course was uneventful in all patients. The mean postoperative hospital stay was shorter than 24 h, and all patients were discharged at first day postoperatively. No postoperative complications including seroma, wound infection, and trocar-site hernia were observed at 6-month follow-up.Conclusion: We described a new access site for single-incision laparoscopic cholecystectomy using standard laparoscopic instruments. We believe that this type of

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Single incision versus reduced port splenectomy—searching for the best alternative to conventional laparoscopic splenectomy

Abstract: RPAS is a good alternative to LS and SPAS. It improves the aesthetic results as compared to LS, whereas minimizes the technical challenges faced with SPAS.

Cited by 26 publications

References 21 publications

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

Extraumbilical Single-Incision Laparoscopic Cholecystectomy with Standard Laparoscopic Instruments

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