It is essential to continue our dissection posterior
and inferior to the spleen as far as possible. Its purpose is to
sufficiently expose the posterior aspect of the splenic hilum. The entire
anterior aspect of the hilum should also be well-visualized. This manuever
will prepare the path of the ENDO GIA ™ Instrument to safely transect the
In addition, the operator should be very careful not
to place any Endoclips on the path of the ENDO GIA* stapler as it will
impair its function and hemostatic capability.
Occasionally, the short gastric vessels will have to
be first transected to gain additional exposure.
An ENDO GIA* 30 (or ENDO GIA* II) is inserted and
each jaw should be positioned anterior and posterior to the splenic vessels.
Although this maneuver appears very audacious to the neophyte, complete
hemostasis of the splenic hilum is usually achieved. The instrument is
fired several times in sequence.
[The same transection of the splenic vessels can
also be performed using the ENDO CLIP* Applier. This, however is very time
consuming and no no longer recommended.]