Laparoscopic splenectomy is emerging as the procedure of choice for splenic removal in patients with hematologic disorders and normal to moderately enlarged spleens. We herein describe our technique for laparoscopic splenectomy. Alternative techniques are also discussed, with detailed modifications of techniques for patients with splenomegaly.
Operating room setup.
Trocar placement. Ports 1 and 4 are 5 mm, ports 2 and 3 are 12 mm, and port 5 is 11 mm in diameter. Port 5 should be placed to visualize the spleen between ports 2 and 3.
After exploration, the dissection of the splenic attachments is begun with the splenocolic ligament (arrow). Traction is always placed toward the spleen with countertraction, if necessary. C indicates colon; D, diaphragm.
The gastrosplenic ligament is divided (arrow). Dissection is begun at the inferior aspect and continued until all short gastric vessels are divided. The superior medial aspect of the splenophrenic ligament is also divided. S indicates stomach; P, pancreas; D, diaphragm; and H, hilum.
The splenorenal ligament (arrow) is divided, retracting the spleen anteriorly. Areolar connective tissue between this ligament and the splenic hilum is gently divided. C indicates colon; D, diaphragm.
The gastrophrenic ligament is divided (arrow), and areolar connective tissue again is dissected. At the completion of this step, the splenic hilum has been mobilized circumferentially. D indicates diaphragm; H, hilum.
If the splenic artery can be identified superior to the tail of the pancreas, it is ligated (arrow). S indicates stomach; D, diaphragm; P, pancreas; and H, hilum.
The splenic hilum is now divided with the spleen retracted far into the left upper quadrant. After transection, the spleen is placed in a bag, morcellated, and removed. P indicates pancreas; D, diaphragm; and S, stomach.
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