The patient is placed in lateral decubitus, and the access to the abdominal cavity is gained using a 12-mm optic bladeless trocar (Excel Endopath, Ethicon Endo-Surgery, Cincinnati, OH) introduced through the umbilicus. We routinely used a 10-mm flexible-tip HD scope (Endoeye, Olympus). A subcostal 5-mm trocar is placed under direct vision at the level of the anterior axillary line. Finally, a 3-mm port is inserted at the midepigastric region (Fig. 7.2). The sequential steps are essentially the same as with SPAS. Using a 5-mm harmonic scalpel (HARMONIC ACE, Ethicon Endo-Surgery) and 3-mm instruments (Storz, Tuttlingen), access was gained to the lesser sac by dividing the gastrosplenic ligament and short vessels until the upper pole of the spleen. Every attempt was made to ligate the splenic artery at the superior border of the pancreas to allow some shrinkage of the spleen. Next, splenic flexure of the colon was mobilized to get the lower pole of the spleen freed. The table was then tilted to the right to obtain a good exposure of the retrosplenic area, taking advantage of gravity. The posterior splenorenal ligament was then freed. Once the spleen was completely dissected free from all of its attachments, the optic was changed for a 5-mm, 30° scope introduced through the left hypochondrium trocar, and a stapler with a 60-mm white cartridge (Echelon, Ethicon Endo-Surgery) was deployed through the umbilical port, advanced to the splenic fossa, and fired to divide the splenic artery and vein at the level of the hilum. A 15-mm endobag (Endo Catch II, Covidien, Mansfield, MA) was used to retrieve the spleen after being morcellated trough the umbilical incision. A drain, exteriorized through the lateral 5-mm trocar, was used selectively.

A systematic search in PubMed (June 2013) was performed. The applied search strategy included the key words: (single incision OR single port) AND (laparoscopic OR laparoendoscopic OR robotic) AND splenectomy.

The main characteristics of the studies (demographics, medical history, clinical features of SILS performed, operative parameters, outcomes) are depicted in Table 7.1 [5–34]. A total of 81 patients were retrieved. The age ranged from 0.6 to 73 years. The majority of them were female (57 %). The median body mass index of the included patients was 23 kg/m² (range: 18–36). Partial splenectomy was performed in two cases (2.5 %). The patients were positioned either in semi-lateral (62 %) or lateral position (38 %). The most frequent surgical approach was through the umbilicus (91 %), while the supraumbilical (6 %) or left upper quadrant (2.5 %) was also used. The median weight of the spleen was 446 g (125–590 g). Regarding the utilized port system, a multitrocar system (5–12-mm trocars) were applied in (54 %) patients, SILS® port in 27 %, TriPort® in six (8 %), glove ports in five (6 %), and GelPort® in four patients (5 %).

The median operative time was 125 min (45–420), while the median blood loss was 50 ml (10–450 ml). In 5 % a conversion was needed either to open or to multiport laparoscopic surgery, while transfusion was needed in 11 cases (14 %). The hospital stay ranged between 1 and 9 days. Complications related to splenectomy occurred in 7 % of patients. No death of patients was reported. Simultaneously, we identified five case series that included 58 SILS patients (Table 7.2) [4, 35–38]. Only in one study, the final cosmesis of the surgical wounds was evaluated with the difference being statistically significant in the single-incision group compared to the classical laparoscopic one. A similar systematic review has recently been published [39].