Laparoscopic splenectomy: strictly posterior approach for HIV thrombocytopenia

The video demonstrates a posterior lateral approach to mobilization of the splenic hilum in a patient with a large spleen. The division of the lateral attachments allows the spleen to fall forward and thus open up the window to the vascular pedicles, which are then dissected and clipped and divided. The pancreatic tail is visualized and protected during the dissection. The specimen is put into a large bag and retrieved through an enlarged port site.

This "live" surgery demonstrates the posterior approach to splenectomy. Dr. Mutter, MD, PhD, describes each step of the procedure as he performs it. There is an interactive discussion with the audience. The tail of the pancreas was adherent to the splenic hilum and the LigaSure device is used to discover this plane.

The authors mark the margin of costal margin and place a 12-mm trocar through an incision at the anterior costal margin. They then place a 5-12 mm trocar 5 cm anterior to the first trocar, and a third 5-cm trocar 3-4 cm below the costal margin.