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

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Abstract

Background

Laparoscopic splenectomy (LS) is a well accepted approach for the treatment of multiple hematologic diseases. Single port access splenectomy (SPAS) emphasizes the concept of surgery through one small incision. The reduced port access splenectomy (RPAS) entails the use of fewer trocars of smaller sizes. The aim of this study was to compare the clinical outcomes after LS, SPAS, and RPAS, and to analyze the aesthetic result and patient satisfaction.

Methods

We included patients who underwent LS (group 1, n = 15), SPAS (group 2, n = 8), and RPAS (group 3, n = 10) between June 2008 and February 2012, whose final spleen weight was less of 500 g. The outcome parameters analyzed were operative time, need of additional trocars, blood loss, blood transfusion, weight of the spleen, postoperative complications, and duration of hospital stay. To evaluate the cosmetic result, patients were asked to take the Body Image Questionnaire.

Results

Patients in group 3 were younger than group 1. Operative time was significantly longer in group 2 compared to groups 1 and 3 (83 ± 19 vs. 131 ± 43 vs. 81 ± 22 min, p = 0.01). There was no need to convert to open surgery in any group, nor were there differences in intra- or postoperative outcome. There were no differences between the groups in relation to the analgesic requirements. Twenty-two out of the 33 patients answered the questionnaire. There was a significant advantage in group 2 and 3 in the body image index with respect to group 1. There were no differences between groups 2 and 3 (7.3 ± 2.8 vs. 5.8 ± 1.3 vs. 5.1 ± 0.4, p < 0.02).

Conclusions

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.

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Disclosures

Drs. Julio Lopez, Eduardo Targarona, Pablo Vidal, Yerald Peraza, Francisco Garcia, Carlos Rodriguez, Luis Pallares, Carmen Balague and Manuel Trias have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Mas Casanovas 90, 4th floor, 08041, Barcelona, Spain

    Julio Lopez Monclova, Eduardo M. Targarona, Pablo Vidal, Yerald Peraza, Francisco Garcia, Carlos Rodriguez Otero, Luis Pallares, Carmen Balague & Manuel Trias

Authors
  1. Julio Lopez Monclova
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  2. Eduardo M. Targarona
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  3. Pablo Vidal
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  4. Yerald Peraza
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  5. Francisco Garcia
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  6. Carlos Rodriguez Otero
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  7. Luis Pallares
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  8. Carmen Balague
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  9. Manuel Trias
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Corresponding author

Correspondence to Julio Lopez Monclova.

Appendix

Appendix

Satisfaction survey and aesthetic outcome after laparoscopic splenectomy

1. Are you less satisfied with your body since the operation?

 Range

  1 = no, not at all

  2 = a little bit

  3 = quite a bit

  4 = yes, extremely

2. Do you think the operation has damaged your body?

 Range

  1 = no, not at all

  2 = a little bit

  3 = quite a bit

  4 = yes, extremely

3. Do you feel less attractive as a result of your disease or treatment?

 Range

  1 = no, not at all

  2 = a little bit

  3 = quite a bit

  4 = yes, extremely

4. Do you feel less feminine/masculine as a result of your disease or treatment?

 Range

  1 = no, not at all

  2 = a little bit

  3 = quite a bit

  4 = yes, extremely

5. Is it difficult to look at yourself naked?

 Range

  1 = no, not at all

  2 = a little bit

  3 = quite a bit

  4 = yes, extremely

6. On a scale from 1 to 7, how satisfied are you with your (incisional) scar?

Very unsatisfied

Not unsatisfied/not satisfied

Very satisfied

1

2

3

4

5

6

7

7. On a scale from 1 to 7, how would you describe your (incisional) scar?

Revolting

Not revolting/not beautiful

Beautiful

1

2

3

4

5

6

7

8. Could you score your own incisional scar on a scale from 1 to 10?

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Monclova, J.L., Targarona, E.M., Vidal, P. et al. Single incision versus reduced port splenectomy—searching for the best alternative to conventional laparoscopic splenectomy. Surg Endosc 27, 895–902 (2013). https://doi.org/10.1007/s00464-012-2530-y

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  • DOI: https://doi.org/10.1007/s00464-012-2530-y

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