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Aim: To study the feasibility and efficiency of transumbilical single-incision laparoscopic surgery splenectomy (SILS-Sp) using conventional instruments in consecutive patients and to compare outcomes of the procedure with those of standard multiple-incision laparoscopic splenectomy (MLS)., Patients and Methods: A retrospective review was conducted to evaluate all SILS-Sp procedures performed by a single surgeon between March 2010 and January 2013. Additionally, patients who underwent MLS by other surgeons in the same surgical group during the same period were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed., Results: Thirteen patients underwent successful SILS-Sp during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 165 minutes. There was 7.7% morbidity and no mortality in the study group. Median length of stay was 8.8 days. Additionally, 12 patients who underwent MLS were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. For MLS, the median operative time was 158 minutes. There was 8.3% morbidity and no mortality in the group. Median length of stay was 8.3 days. SILS-Sp using conventional instruments was associated with reduced postoperative pain scores, but this did not reach statistical significance. The operative time, conversion rate, and length of stay were equivalent. The mortality, morbidity, and cost were also similar in the two groups. The umbilical incision of the single-incision group can be easily hidden in the umbilical fold with ideal cosmetic result., Conclusions: SILS-Sp is feasible and efficient in an unselected patient population in the hands of an experienced laparoscopic surgeon. The single-incision technique is comparable to standard laparoscopic splenectomy in terms of operative time and perioperative outcomes. Ideal cosmetic effect may be its potential advantage.

Objective: The aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic splenectomy (SILS-Sp)., Methods: We conducted a systemic review of literature between 2009 and 2012 to retrieve all relevant articles., Results: A total of 29 studies with 105 patients undergoing SILS-Sp were reviewed. Fifteen studies used a commercially available single-port device. The range of body mass index was 14.7-41.4 kg/m(2). Six studies described combined operations including cholecystectomy (n = 8), mesh-pexy (n = 1), and pericardial devascularizaion (n = 1). The ranges of operative times and estimated blood losses were 28-420 min and 0-350 mL, respectively. Of 105 patients, three patients (2.9%) required additional ports, two patients (1.9%) were converted to open, and three patients (2.9%) to conventional multiport laparoscopic splenectomy (overall conversion rate, 4.8%). Postoperative bleeding occurred in two patients (1.9%) who both required reoperation. Overall mortality was 0% (0/105). The length of postoperative stay varied across reports (1-11 d). Among four comparative studies, one showed greater estimated blood loss and lower numeric pain rating scale score in the SILS-Sp group than in the multiport laparoscopic splenectomy group (206.25 ± 142.45 versus 111.11 ± 99.58 mL) and (3.81 ± 0.91 versus 4.56 ± 1.29), respectively. Another comparative study showed that SILS-Sp was associated with a shorter operative time (92.5 versus 172 min; P = 0.003), lower conversion rate, equivalent length of hospital stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements., Conclusions: In early series of highly selected patients, SILS-Sp appears to be feasible and safe when performed by experienced laparoscopic surgeons. However, as an emerging operation, publication bias is a factor that should be considered before we can draw an objective conclusion., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: Laparoendoscopic single-site surgery (LESS) has been proposed for several intra-abdominal surgical interventions. However, application of the LESS technique in portal hypertension is still in its infancy. We report in this article a new technique of LESS splenectomy plus pericardial devascularization with conventional laparoscopic instruments in patients with portal hypertension., Patients and Methods: From January 2010 to April 2012, LESS splenectomy plus pericardial devascularization was performed on 5 patients with portal hypertension. Surgical techniques and short-term outcomes were summarized and analyzed retrospectively., Results: All the operations were successful with a mean operative duration of 252 minutes (range, 220-270 minutes), intraoperative blood loss of 290 mL (range, 250-350 mL), and hospital stay of 8.2 days (range, 7-9 days). No intraoperative or postoperative complications were recorded. The umbilical incision healed well with a satisfactory cosmetic effect., Conclusions: LESS splenectomy plus pericardial devascularization is feasible when performed by experienced laparoscopic surgeons and may offer safety comparable to that of the conventional laparoscopic operation.

Aim: The authors report 1 case of emergency splenectomy for the treatment of traumatic rupture of the spleen where a laparoendoscopic single-site surgery technique was performed., Method: A 17-year-old male with a diagnosis of traumatic rupture of the spleen underwent emergency transumbilical single-incision laparoscopic splenectomy. Three ports, including 5 mm and 10 mm ports, were placed through a transumbilical incision for the procedure., Results: Intraoperative and postoperative courses were uneventful. The patient was discharged home 8 days after the surgery in a stable condition. Discussion. The Laparoendoscopic single site surgery technique is still in its infancy, but because of its reduced invasion and ideal aesthetic results, it is well received by patients. Improvements are needed to widen its application., Conclusion: To the authors' knowledge, this is the first report where an emergency laparoendoscopic single site surgery technique has been used in the management of a ruptured spleen.

Objective: To summarize the clinical experiences of laparoendoscopic single-site splenectomy., Methods: From January 2010 to June 2010, laparoendoscopic single-site splenectomy was performed in 4 patients, including traumatic rupture (n = 1), hypersplenism (n = 1), splenic aneurysm (n = 1) and cardia cancer with invasiveness to spleen (n = 1)., Results: All operations were successful with an operative duration 180 - 360 min, a volume of intraoperative blood loss 100 - 400 ml and a hospital stay 7 - 9 days. All patients stayed free of such postoperative complications as hemorrhage, pancreatic leakage, venous thrombosis and fever. The umbilical incision healed well with satisfactory cosmetics., Conclusion: Laparoendoscopic single-site splenectomy is both safe and feasible for experienced laparoscope surgeons.

Aim: To determine and compare the effect of vagus nerve on gallbladder motility in patients with hepatic cirrhosis before and after portal azygous disconnection (PAD)., Methods: PAD operation (or Hassab's operation) was performed on 18 patients with portal hypertension, and anterior and posterior vagal trunks were cut. On d 3 before operation and d 10 after operation, (99m)Tc-EHIDA 185 MBq was administered intravenously to the patients, and scintigraphy was performed at 0.25 min/frame. A standard fat meal was administered 30 min after scintigraphy, and dynamic imaging was performed 60 min after the fat meal. Following appearance of the region of interest (ROI) in gallbladder, the time-activity curve of ROI was established. The following seven parameters were used: radioactivity at 30 min after injection of (99m)Tc-EHIDA (RC 30 min), bile emptying fraction (EF), bile emptying period (EP), emptying rate (ER), latent period (LP), latent period radiocounting increment (LI), and latent period radiocounting increment rate (LR)., Results: The RC 30 min decreased significantly after operation, compared with that before operation (2 693.6+/- 2 406.9 vs 5 606.8+/-2 625.4, P<0.05). The radiocounting of gallbladder increased gradually during LP. LP after operation was significantly longer than that before operation (13.36+/-5.92 vs 2.24+/-1.48, P<0.01). LI and LR after operation were significantly higher than those before operation (2 861.62+/-028.3 vs 331.21+/-421.02, and 113.42+/-49.52 vs 7.57+/-10.75, respectively, both P<0.01). EP after operation was significantly shorter than that before operation (18.5+/-6.3 vs 24.1+/-6.4, P<0.05). EF and ER after operation were significantly lower than those before operation (13.1+/-5.4 vs 32.3+/-16.3, and 0.7+/-0.3 vs 1.4+/-0.8, respectively, both P<0.01)., Conclusion: PAD operation is a good clinical model in studying the effect of vagus on gallbladder motility. The gallbladder tension after PAD operation decreases significantly during the interdigestive phase. The latent period of gallbladder contraction prolongs and the motility weakens apparently after a standard fat meal. Human vagus influences the gallbladder motility, and cutting of the nerve inhibits the gallbladder motility.