Laparoscopic fenestration of a symptomatic primary splenic cyst using a single port access approach

Non-neoplastic cysts of the spleen are rare and their management has evolved from total open splenectomy to laparoscopic cyst decapsulation. The aim of this video is to present a lesser invasive laparoscopic splenic cyst fenestration using a transumbilical single port device.

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Laparoscopic fenestration of a symptomatic primary splenic cyst using a single port access approach

Authors

Abstract

Non-neoplastic cysts of the spleen are rare and their management has evolved from total open splenectomy to laparoscopic cyst decapsulation.
The aim of this video is to present a lesser invasive laparoscopic splenic cyst fenestration using a transumbilical single port device.

Catégorie

single port, contribution

Mots-clés

Laparoscopic fenestration, symptomatic primary splenic cyst, single port access approach, unroofing

Type de vidéo

Vidéo chirurgicale

Durée

07'20''

Publication

2009-07

Popularité

Favoris

Favorites Media

Audio

Sous-titres

E-publication

WeBSurg.com, Jul 2009;9(07).
URL: http://www.websurg.com/doi-vd01en2701.htm

Laparoscopic fenestration of a symptomatic primary splenic cyst using a single port access approach

1. Introduction 00'17''

The aim of this video is to show the trans-umbilical single access approach of a benign splenic cyst.

2. Clinical case presentation 00'22''

A 26-year-old girl complained of unspecific pain in the left hypochondrium. On a CT-scan, she was diagnosed with a 12cm cystic lesion located in the lower pole of the spleen.

3. Umbilical incision 00'38''

With the patient placed in a left lateral decubitus, a 20mm umbilical incision is performed.

4. Single port device and instruments insertion 01'02''

Once the pneumoperitoneum has been established, a single port device (TriPort) is inserted through the umbilicus. We use a 10mm flexible tip scope, a 5mm scope as well as 5mm and 3mm instruments, and the ultrasonic scalpel. The tip of the flexible scope was placed in front of the spleen. A 5mm curved grasper used for TEM dissection is placed through the left trocar and a conventional 5mm ultrasonic scalpel is introduced on the right. Using this approach, it was possible to reach and explore the lower pole of the spleen.

5. Cyst puncture 02'16''

After an explorative laparoscopy, the cyst is punctured and its content is aspirated.

6. Cyst wall resection 02'49''

Once the cyst is empty, the cyst wall is resected until the normal splenic tissue is reached.

7. Specimen extraction 06'17''

After checking for hemostasis, a 10mm Endobag is inserted replacing the 12mm trocar, and the cyst wall fragments are extracted. Histopathological analysis showed features of a primary epithelial cyst. The postoperative outcome was uneventful and the patient was discharged at 48 hours. Single port trans-umbilical access can be safely used for operative visualization and cyst fenestration reducing parietal wall trauma to a minimum.