Minilaparoscopic splenectomy: a new minimally invasive approach.

This report introduces our new technique in laparoscopic splenectomy. A 2-mm minilaparoscope and a conventional 10-mm laparoscope were used alternatively during the procedure, with a result of nearly no visible scar after the operation. Two young females diagnosed with idiopathic thrombocytopenic purpura, refractory to medical treatment, underwent laparoscopic splenectomy in our hospital. The whole procedure was finished through one 12-mm port (supraumbilical) and three 2-mm ports (subxiphoid, left midclavicular, and left midaxillary). The short gastric vessels and splenic vessels were clipped and divided by Endo-GIA II (U.S. Surgical Corp., Norwalk, CT) that was applied through the 12-mm port. The spleen was placed in a bag and was fractured to be removed piece by piece. A drain tube was not necessary after meticulous hemostasis. Two weeks after the operation, only three tiny wounds, resembling mosquito bites, were present at the left subcostal region. In conclusion, minilaparoscopic splenectomy is feasible and safe for patients with idiopathic thrombocytopenic purpura, and may ultimately be an alternative choice for patients desiring superior cosmesis.