The patient fully consented to the operation and also signed a detailed information consent form. Ultrasound indicated that the spleen was of normal in size. Her biochemical parameters were in normal ranges. During the ongoing medical treatment, steroid resistance developed and the patient was consulted for splenectomy. Her platelet counts were ranging between 1,000 and 26,000 mm 3 at the beginning of the medical treatment, and she responded well to steroid therapy as rising to 203,000 mm 3. Physical examination revealed a Pfannenstiel incision. Her body mass index (BMI) was 31 kg/m2 and American Society of Anesthesiologists (ASA) score was II. Case PresentationĪ 43-year-old female who initially presented with spontaneous nosebleeds was diagnosed with ITP and had been followed for three years with medical treatments. We only placed two 5 mm umbilical trocars (mini-laparoscopy) and the spleen was removed through the vagina (natural orifice surgery). Herein, we demonstrated a laparoscopic splenectomy with rigid instruments without using staplers, clips, or sutures. Despite those potential benefits, there were only two reported transvaginal splenectomies both used flexible scopes, endostaplers for hilum transections, and extraumbilical trocars. A recent meta-analysis demonstrated that it has some advantages, such as less postoperative pain, low hernia risk, and faster recovery. Natural orifice transluminal endoscopic surgery (NOTES), which is modified from laparoscopic surgery, reduces the number of ports and does not produce any visible surgical scar. There were a limited number of reported mini-laparoscopic splenectomies, and all had a 12 mm abdominal trocar for stapling or specimen extraction that made questionable the rationality of the mini-laparoscopy. Mini-laparoscopic (< 5 mm trocars) surgery can also be used successfully for splenectomy there will be less abdominal wall trauma that results in almost no risk of an incisional hernia, less postoperative pain, and a superior cosmetic outcome. Laparoscopic splenectomy is an effective and reliable technique, resulting with shorter hospital stays with fewer surgical complications and better esthetic results. It became the “gold standard” for surgical treatment of some hematological disorders, such as immune thrombocytopenic purpura (ITP). Since laparoscopic splenectomy was first successfully performed by Delaitre in 1992, there has been a dramatic increase in the proportion of laparoscopic cases with acceptable outcomes. Splenectomy is a common procedure for the management of spleen-related hematological disorders. The transvaginal approach seems to be a feasible way to perform natural orifice splenectomy. Additionally, it provided an unfragmented spleen extraction. To the best of our knowledge, this report described the most minimal invasive splenectomy even. Platelet values increased to 408.000 mm 3 in the follow-up. She did not require any analgesics postoperatively. Her postoperative course was uneventful and she was discharged on day two without complication. No drain or abdominal fascia suturing was used but closing the posterior fornix of the vagina. The operating time was 200 minutes and the blood loss was minimal (< 20 ml).
#Stapled vagina free
As the spleen became completely free in the abdomen, it was removed through the vagina in a bag without fragmentation. The transvaginal port was used for dissection and division of the spleen by a 10-mm LigaSure Atlas vessel sealing system. The 5 mm umbilical ports were used for camera and retraction of the spleen. A 15 mm trocar was inserted through the posterior fornix of the vagina under umbilical laparoscopic vision. We did not use any single port device or similar modifications.
Two 5 mm trocars were inserted separately through the umbilicus. She had a history of a previous cesarean section for three times. A 43-year-old female (BMI 31 kg/m 2, ASA II) with immune thrombocytopenic purpura was planned for splenectomy. We aimed to perform a more and more minimal invasive splenectomy by only through two 5 mm umbilical trocars and one vaginal trocar.
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