Technique Of Laparoscopic Splenectomy: How I Do It

Laparoscopic splenectomy (LS) is the gold standard procedure to remove the spleen in elective patients. The laparoscopic procedure can be performed safely in patients with a massive splenomegaly, too. Despite many authors prefer the lateral approach, we put the patients in a supine position. This position offers good exposition of the splenic vessels and allows for a rapid control of hilar blood flow. Moreover, the supine approach does not require the retraction of the spleen away from hilum, this allows the procedure to be carried out in most cases without the need to insert a fourth trocar. We control the hilum vessels, after closing the main trunk of the splenic artery with a hem-o-lok, with one firing of an endoscopic stapler loaded with a vascular cartridge, providing that the tail of the pancreas is protected and all hilar structures can be included between the jaws of the stapler. We call this method the stapling technique. LS provides the advantages of shorter length of stay, decreased postoperative pain, and morbidity, but it should be performed using standardized technique by skilled and experienced surgeons.