Laparoscopic Splenectomy

The pneumo-peritoneum is created and the intra-abdominal cavity explored. The presence or absence of accessory spleen should be verified. [Early on in this series we routinely clipped the splenic artery and vein in the lesser sac. This technical step had now been abandoned].

An ENDO RETRACT II ™  Instrument is inserted and will lift the inferior aspect spleen superiorly. The tail of the pancreas should be identified.  The spleno-renal and colo-splenic ligaments are divided with sharp dissection. The dissection is continued superior and lateral to mobilize the entire spleen.

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 Splenic Hilum.

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.]

 

The short gastric vessels are best divided using the ENDOGIA™ Instrument. Each time the spleen is moved superiorly, inferiorly or medially with the ENDO RETRACT II ™ Instrument.

The spleen should be entirely detached.

The most lateral 12 mm trocar is removed, iits site is enlarged and replaced  by 15mm  trocar. An ENDO CATCH* II instrument is inserted  and deployed in the intra-abdominal cavity. The spleen is placed in the specimen retrieval bag. The specimen retrieval bag is closed and brought against the anterior abdominal wall. It is open via the enlarged trocar site. The spleen is then sectioned in smaller pieces in the specimen retrieval bag and removed with a large clamp.

A Blake™ Drain is left in the intra-abdominal cavity. The abdomen is deflated, the trocars removed.