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Laparoscopic partial splenectomy
A 39-year-old male patient was referred to our institution for a total laparoscopic splenectomy. The patient presented a CT-scan with a heterogeneous lesion in the lower aspect of the spleen. Two different hematologists-oncologists recommended a total splenectomy due the characteristics of the lesion. We discussed this recommendation during the oncological committee at our institution and due to the anatomical variation of the splenic artery and the absence of characterization of the lesion as 100% malignant, a laparoscopic partial splenectomy was decided upon with an intraoperative frozen analysis to determine if any further resection would be necessary. In this video, the authors present the technical aspects of a complex surgical resection.
D Awruch, M Grimoldi, M Blanco, R Sanchez Almeyra
Surgical intervention
1 year ago
3043 views
179 likes
0 comments
05:28
Laparoscopic partial splenectomy
A 39-year-old male patient was referred to our institution for a total laparoscopic splenectomy. The patient presented a CT-scan with a heterogeneous lesion in the lower aspect of the spleen. Two different hematologists-oncologists recommended a total splenectomy due the characteristics of the lesion. We discussed this recommendation during the oncological committee at our institution and due to the anatomical variation of the splenic artery and the absence of characterization of the lesion as 100% malignant, a laparoscopic partial splenectomy was decided upon with an intraoperative frozen analysis to determine if any further resection would be necessary. In this video, the authors present the technical aspects of a complex surgical resection.
Laparoscopic splenectomy in a patient with cirrhosis and splenomegaly
Introduction
The first laparoscopic splenectomy was initially described more than 20 years ago. Hypersplenism associated with thrombocytopenia in cirrhotic patients could compromise quality of life and also limit therapeutic options such as interferon treatment.
Material and methods
We present the case of a 48-year-old woman with a history of parenteral drug abuse, HCV/HIV co-infection, cirrhosis (Child-Pugh B). Treatment with interferon and antiretrovirals must be discontinued for severe thrombocytopenia. As a result, laparoscopic splenectomy stands out as a therapeutic measure.
Results
In this video, we present a laparoscopic splenectomy approach in a cirrhotic patient with splenomegaly and hypersplenism in order to initiate interferon and antiretroviral treatment. It is possible to note the presence of collateral circulation, cirrhotic liver, and moderate splenomegaly (final spleen weight of 735 grams).
Conclusions
Laparoscopic access proves safe and effective in cirrhotic patients in order to extend the therapeutic managements of their underlying diseases. It can also improve the Child-Pugh score.
C Rodríguez-Otero Luppi, EM Targarona Soler, C Balagué Ponz, JL Pallarés Segura, M Trías Folch
Surgical intervention
5 years ago
7046 views
131 likes
0 comments
08:01
Laparoscopic splenectomy in a patient with cirrhosis and splenomegaly
Introduction
The first laparoscopic splenectomy was initially described more than 20 years ago. Hypersplenism associated with thrombocytopenia in cirrhotic patients could compromise quality of life and also limit therapeutic options such as interferon treatment.
Material and methods
We present the case of a 48-year-old woman with a history of parenteral drug abuse, HCV/HIV co-infection, cirrhosis (Child-Pugh B). Treatment with interferon and antiretrovirals must be discontinued for severe thrombocytopenia. As a result, laparoscopic splenectomy stands out as a therapeutic measure.
Results
In this video, we present a laparoscopic splenectomy approach in a cirrhotic patient with splenomegaly and hypersplenism in order to initiate interferon and antiretroviral treatment. It is possible to note the presence of collateral circulation, cirrhotic liver, and moderate splenomegaly (final spleen weight of 735 grams).
Conclusions
Laparoscopic access proves safe and effective in cirrhotic patients in order to extend the therapeutic managements of their underlying diseases. It can also improve the Child-Pugh score.
SILS single port splenectomy in a woman diagnosed with idiopathic thrombocytopenia
Laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen since its first description in 1991. Indications for LS have rapidly increased and LS is now considered the standard approach for the treatment of benign and malignant hematologic disorders, especially by young patients who find small scars cosmetically preferable.
Single incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. In this video, we present an original technique of SILS splenectomy in a woman diagnosed with idiopathic thrombocytopenia. A 2.2cm left subcostal incision lateral to the rectus muscles was used for the placement of the single port device with conventional laparoscopic instruments, using a Veress needle covered by a small sponge to lift the spleen that was removed through the same incision.
F Corcione, F Pirozzi, F Galante
Surgical intervention
6 years ago
2524 views
38 likes
0 comments
05:51
SILS single port splenectomy in a woman diagnosed with idiopathic thrombocytopenia
Laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen since its first description in 1991. Indications for LS have rapidly increased and LS is now considered the standard approach for the treatment of benign and malignant hematologic disorders, especially by young patients who find small scars cosmetically preferable.
Single incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. In this video, we present an original technique of SILS splenectomy in a woman diagnosed with idiopathic thrombocytopenia. A 2.2cm left subcostal incision lateral to the rectus muscles was used for the placement of the single port device with conventional laparoscopic instruments, using a Veress needle covered by a small sponge to lift the spleen that was removed through the same incision.
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
L Boni, G Dionigi, M Di Giuseppe, E Colombo, L Giavarini, F Cantore, R Dionigi
Surgical intervention
8 years ago
1633 views
13 likes
0 comments
04:58
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
C Conrad
Lecture
2 years ago
958 views
67 likes
0 comments
15:24
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
Laparoscopic splenectomy for splenomegaly: anterior posterior approach and ‘hanged technique’
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.
EM Targarona Soler
Surgical intervention
12 years ago
680 views
120 likes
0 comments
08:27
Laparoscopic splenectomy for splenomegaly: anterior posterior approach and ‘hanged technique’
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.
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
R Araujo, MA Sanctis, F Felippe, D Burgardt, D Wohnrath
Surgical intervention
5 months ago
1060 views
2 likes
0 comments
08:04
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
Laparoscopic en bloc splenopancreatectomy with left adrenalectomy and para-aortic lymphadenectomy
The objective of this video is to present a surgical approach to a left adrenal mass caused by the invasion of a pancreatic lesion. A pulmonary lesion was also found. However, a preoperative biopsy of that lesion was impossible to perform. In order to distinguish the primary origin of this lung lesion, a laparoscopic ‘en bloc’ splenopancreatectomy combined with a left adrenalectomy and a para-aortic lymphadenectomy were planned.
Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. In the literature, fewer studies describe the feasibility and the oncological safety of the laparoscopic approach.
This video aims to show the different operative steps of the procedure beginning with laparoscopic adrenalectomy followed by distal pancreatectomy and para-aortic lympadenectomy.
R Romito, L Portigliotti, G Bondonno, M Zacchero, A Volpe
Surgical intervention
5 months ago
1183 views
11 likes
0 comments
13:28
Laparoscopic en bloc splenopancreatectomy with left adrenalectomy and para-aortic lymphadenectomy
The objective of this video is to present a surgical approach to a left adrenal mass caused by the invasion of a pancreatic lesion. A pulmonary lesion was also found. However, a preoperative biopsy of that lesion was impossible to perform. In order to distinguish the primary origin of this lung lesion, a laparoscopic ‘en bloc’ splenopancreatectomy combined with a left adrenalectomy and a para-aortic lymphadenectomy were planned.
Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. In the literature, fewer studies describe the feasibility and the oncological safety of the laparoscopic approach.
This video aims to show the different operative steps of the procedure beginning with laparoscopic adrenalectomy followed by distal pancreatectomy and para-aortic lympadenectomy.
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.
J Magalhães, C Osorio, L Frutuoso, AM Pereira, A Trovão, R Ferreira de Almeida, M Nora
Surgical intervention
6 months ago
3906 views
15 likes
0 comments
09:44
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.