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Laparoscopic splenectomy in the supine position using the internal approach technique Akihiko MORITA 1 , Yukari YAMAGUCHI 1 , Ichiro ONISHI 1 , Masato KAYAHARA 1 1Department of Surgery, Kanazawa Medical Center Keyword: 腹腔鏡下脾臓摘出術 , 仰臥位 , 脾門部先行処理 pp.661-667
Published Date 2014/9/15
DOI https://doi.org/10.11477/mf.4426101148
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Laparoscopic splenectomy is widely performed in the right(semi) lateral position and the lienorenal ligament is dissected laterally before the splenic pedicle ligation. However it is difficult to ensure a satisfactory operative field especially in patients with splenomegaly. We developed laparoscopic splenectomy by internal approach technique. We don't touch the spleen almost until the splenic pedicle is divided. This method provides a satisfactory surgical view and less operative blood loss. [method] After ligation of the gastrosplenic ligament, the pancreatic capsule is divided just below the pancreas. Toldt' fusion fascia is widely divided between pancereas and left kidney, and tunneling procedure is done from the pancreatic tail to the splenic hilum. The splenic pedicle is clumped and divided by linear stapler. By moderate lifting of the spleen using forceps, the lienorenal ligament between the spleen and retroperitoneal tissue is exposed, then incision of the ligament can be done easily and the spleen is isolated. [Results] We perfomed laparoscopic splenectomy using this approach in four patients. The weight of the spleen was more than 600g in all cases. The mean time until isolation of the spleen and amount of blood loss during operation were 115min and 10g, respectively. No intraoperative complication occurred. [Conclusion] Laparoscopic splenectomy by internal approach technique is a safe and useful procedure regardless of the size of the spleen.


Copyright © 2014, JAPAN SOCIETY FOR ENDOSCOPIC SURGERY All rights reserved.

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電子版ISSN 2186-6643 印刷版ISSN 1344-6703 日本内視鏡外科学会

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