What is the laparoscopic approach to surgery for splenic infarct?

Updated: Jul 27, 2020
  • Author: Manish Parikh, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Laparoscopic approach

For the laparoscopic approach, patient position is key to the success of this operation. Choices include the "hanging spleen" technique, in which the patient is in the lateral decubitus position (as described for laparoscopic adrenalectomy). Another option is the "leaning spleen" technique, in which the patient is at a 45º tilt. Both methods require a beanbag or jelly roll positioning pad. Once pneumoperitoneum is established, the splenocolic ligament is usually divided with ultrasonic shears. Next, the lesser sac is entered, and the short gastric vessels are divided.

If the surgeon prefers to "preligate," the splenic artery can be dissected along the superior border of the pancreas and divided with the vascular stapler. Otherwise, if feasible, the splenic vein and artery are exposed first and are dissected 1 cm proximal to the hilum, and they are usually divided with the vascular stapler. Then, the remainder of the spleen is released by dividing the peritoneal attachments with the ultrasonic scalpel.

In other scenarios, the attachments are divided first and the spleen is rolled anteriorly to expose the tail of the pancreas and the hilar vessels posteriorly. These vessels are then transected with the laparoscopic vascular stapler. The spleen is placed into an EndoCatch bag and is morcellated and extracted through the largest trocar site.

Other laparoscopic approaches are the supine approach (with set-up similar to laparoscopic Nissen fundoplication) and the hand-assisted approach. Laparoscopic partial splenectomy also has been described, including for splenic abscess, using the ultrasonic scalpel or radiofrequency ablation for parenchymal division. [26, 27]


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