Laparoscopic splenectomy for splenomegaly: anterior posterior approach and ‘hanged technique’
Epublication WebSurg.com, May 2007;07(05). URL: http://websurg.com/doi/vd01en2135
This video demonstrates a simple yet elegant technique for laparoscopic splenectomy which emphasizes the rotation of the table to obtain the best operative angle. The technique of splenic artery ligation in order to decompress the spleen and reduce its size is demonstrated. The supero-lateral attachments of the spleen are left intact until the very end in order to aid in its retraction. This approach is suitable for intermediate laparoscopic surgeons. The author dissects the splenic artery out in the splenic hilum. Right-angle forceps enable vascular dissection and passage of a silk ligature around the splenic artery. The splenic vein is left intact. As the second phase of operation is completed, the table is rotated to the right for the third phase. In this phase, the author uses the posterior approach to divide the spleno-parietal attachments, then divides the lateral, inferior, and posterior attachments of the spleen with the harmonic scalpel. The spleen is liberated from Gerota’s fascia inferiorly and posteriorly, then gradually rotated anteriorly and to the right. Some cases may also require mobilization of the tail of the pancreas.