Laparoscopic “double-port” splenectomy. A new minimally-invasiveoption in a giant spleen.

tINTRODUCTION: In case of massive splenomegaly, laparoscopic splenectomy (LS) becomes challenging,uncomfortable and risky both for the surgeon and for the patient. As a consequence of ongoing researchto obtain efficient and cheaper “scarless surgery”, single-port technique and hand-assisted devices weredeveloped and improved in this field.PRESENTATION OF CASE: We present the clinical case of a patient affected by idiopathic myelofibrosis(MF) and splenomegaly who was admitted to our Department to perform a splenectomy for a suspected5-cm splenic lesion.DISCUSSION: The splenic longitudinal diameter measured 26 cm. The patient underwent splenectomyby laparoscopy, combining a single-port access and a gel-port device. The operation was completedlaparoscopically. The operating time was 220 min and the estimate blood loss was 100 ml. The patientwas discharged at 11 post-operative day in overall good conditions. Upon pathological analysis the spleniclesion was a localization of diffuse large B-cell Lymphoma in the context of MF.CONCLUSION: this novel “hybrid technique” of splenectomy, combining the advantages of reduced num-ber of abdominal incisions of the single-port technique to those of the hand assistance, is feasible inmassive splenomegaly with good results. Furthermore, the use of the sovrapubic retrieval incision as theintroduction site for the hand assisted device is convincing, since it’s useful for both tasks. Further studieswith large casuistries are necessary to confirm the effectiveness of the technique.