Laparoscopic Partial Splenectomy for a Hemangioma of the Spleen

Abstract

We report the first successful laparoscopic segmentary splenectomy for a spleen neoplasm in pediatrics. Splenic hemangioma is a rare disorder, but remains the most common benign neoplasm of the spleen. The diagnosis is most often made after histological findings of a resected solid spleen tumor. A 2-year-old male presented with recurrent abdominal pain. Ultrasonography and CT showed a hypoechogenic mass involving the spleen pedicle. A laparoscopic approach showed a solid tumor in the lower pole of the spleen extending up to the main vessels. We used four ports: an umbilical 10 mm port for the lens; one in the left lower quadrant 5 mm for the surgeon's right hand; one epigastric 5 mm for retraction and suction; and one 5 mm in the midline, between the umbilicus and the epigastric port, for the surgeon's left hand. The bipolar vessel sealing system was used successfully as the primary method for vessel occlusion. Approaching the upper border of the tumor, we found a splenic upper pole vascular pedicle which was preserved. Transection of the splenic tissue was completed using a monopolar hook and the bipolar vessel-sealing device, following signs of ischemia on the surface of the spleen. The resected spleen was extracted in a bag through a small Pffannestiel incision. Operative time was 75 minutes. The patient was discharged on postoperative day 2. Histologic exam showed a capillary hemangioma. Doppler ultrasound indicates blood supply has been preserved to the residual spleen at 5 months followup. This is the second splenic solid tumor treated by laparoscopy in our institution, and the first successfully resected, preserving splenic tissue. The type of vascular supply and the use of the bipolar system device made a safe and bloodless segmentary splenectomy possible.