Laparoscopic splenectomy: conventional technique and challenges

Abstract

: Laparoscopic approach to splenectomy has become the conventional approach to splenic surgery as it offers many advantages when compared to conventional surgery. Surgical procedure standardization is justified by the difficulty in operating obese patients or on large spleens. A transabdominal approach in the patient lying in a lateral position offers a wide operative space and easily identified landmarks, enabling a safe and repeatable procedure. The successive key steps of the procedure are determined after the completion of a pre-operative CT scan defining the vascular and anatomical relationships of the spleen and its size, thus making it possible to predict the points of surgical difficulties. The dissection is standardized with a first release of the lower pole of the spleen, an approach of the splenic pedicle with ligation of the artery of the splenic vein, a section of the short vessels, and finally the posterior release of the spleen, thereby releasing the spleen completely. This dissection avoids unnecessary manipulations, and prevents accidental rupture of the capsula in order to avoid post-operative splenosis and recurrence of several diseases. By following these steps, vascular control of the spleen enables a safe splenectomy through a laparoscopic route in most patients.