First experience with single incision laparoscopic surgery in Slovakia: Concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis

Abstract

Aims.Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis. Methods. A 2 -3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed. Result. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and despite the small number of cases in the world, we consider the combined laparoscopic approach safe and effective for the treatment of hereditary spherocytosis. Conclusion. According to actually published guidelines, the laparoscopic approach to concomitant splenectomy and cholecystectomy is recommended, but it depends on the availability of appropriately trained surgeons and suitable equipment.

Robotic surgery in a 12-year-old girl to achieve Cholecystectomy and total Splenectomy indicated for complications of hereditary spherocytosis: Case report

“…Patients with hereditary spherocytosis Complicated with symptomatic gallbladder stones and aged more than 6 years have indications of simultaneous removal of the gallbladder and spleen [15,16] . Laparoscopic removal of the gallbladder and spleen for treatment of hereditary spherocytosis and complications has since been reported [17,18] . Splenectomy is safe and helpful for patients with hereditary spherocytosis [19] .…”

Systematic review and meta-analysis of single-incision versus conventional multiport laparoscopic splenectomy

“…Although SILS-SP is successfully performed for certain patients, unfortunately, most publications regarding SILS-SP are case reports with small series. [ 3 4 6 7 8 9 10 11 12 13 14 22 23 ] Inconsistent results even presented such as operative time. [ 4 9 ] Several reviews have evaluated the feasibility and safety of SILS-SP,[ 1 24 25 26 ] but the latest one involved literature searches only up to June 2012,[ 26 ] leading to the selection of a series of case report.…”

Single-site multiport combined splenectomy and cholecystectomy with conventional laparoscopic instruments: Case series and review of literature

“…Costs, efficacy, safety, availability of new instruments and steepness of the learning curve, are important factors to determine the acceptance of a new instruments. Classical SILS that performed with special ports contain some difficulties because all instruments move from one direction to the relevant organ [12] . Podolsky et al [13] reported their experience with more than 100 SILS procedures.…”