Posterolateral approach : An alternative strategy in laparoscopic splenectomy

• Published in: Surgical endoscopy Vol. 12; no. 6; pp. 898 - 900
• Main Authors: KURIANSKY, J, BEN CHAIM, M, ROSIN, D, HAIK, J, ZMORA, O, SAAVEDRA, P, SHABTAI, M, AYALON, A
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.06.1998
• Subjects: Abdomen; Adolescent; Adult; Biological and medical sciences; Child; Female; Follow-Up Studies; Hodgkin Disease - complications; Humans; Laparoscopy; Ligation; Male; Medical sciences; Middle Aged; Pneumoperitoneum, Artificial; Purpura, Thrombocytopenic, Idiopathic - complications; Retrospective Studies; Spherocytosis, Hereditary - complications; Splenectomy - methods; Splenic Artery - surgery; Splenic Diseases - etiology; Splenic Diseases - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Splenectomy; Surgery; Lateral; Splenic disease; Posterior; Surgical approach; Laparoscopy; Endoscopy; Technique
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s004649900740

Laparoscopic splenectomy (LS) is effective and technically feasible for treating various hematological diseases, especially idiopathic thrombocytopenic purpura (ITP). An anterior approach to the vascular pedicle is usually described. However, in this approach to the splenic hilum, the dissection of the splenic artery is often difficult. A total of 13 patients with ITP underwent elective laparoscopic splenectomy. We utilized a laparoscopic posterolateral approach involving dissection of the suspensory ligaments at the lower pole, then dissection and division of the posterolateral attachments, followed by the dissection and ligation of all splenic branches near the splenic parenchyma. This procedure was completed in 11 of our 13 patients and converted to open surgery in the other two patients. Mean operative time was 3 h; mean postoperative stay was 3 days. No blood transfusion was required, and no complications were noted in the postoperative period. The posterolateral approach provides better visualization and control of branches of the splenic vein and artery in the splenic hilum. It also permits visualization and control of surgical hemorrhage through the operating ports.