Laparoscopic Splenectomy - University of Kentucky | Medical Center

Jessica McQuerry
University of Kentucky
College of Medicine
 Female
in early 20’s presents with abdominal
discomfort and feelings of early satiety
 On physical exam, a palpable mass is found
in the left upper abdominal quadrant
A CT scan was
performed and showed
a splenic cyst
 Uncommon
Incidence of 0.07% in general population
 Majority
of cases are due to parasitic
infection with Echinococcus granulosus
resulting in hydatid disease
 Non-parasitic cysts account for < 1/3 of all
splenic cyst cases
Pseudo cyst (75%)
True cyst (25%)
 Surgical
cystectomy or splenectomy
Depends on the size of the splenic cyst
Depends on the position of the cyst in relation to
the splenic hilum
 Indications:
Idiopathic thrombocytopenic purpura (ITP)
Autoimmune hemolytic anemia
Benign tumors and cysts
AIDS-related thrombocytopenia
 Relative
Hematological malignancies
Moderate splenomegaly
 Absolute
Massive splenomegaly
Portal hypertension
 Right
lateral decubitis, flexed at waist
 A cushion is placed under the lumbar fossa to
open up the operating field and facilitate
trocar placement
The surgeon faces the patient, the assistant is behind the patient. They
each have their own video screen. The camera person stands next to the
Optical trocar, 10mm
Operating trocar, 5mm
Mid-axillary line below
left costal margin
Operating trocar, 5mm
Anterior axillary line
below the left costal
Mid-clavicular line, a few
cm below the left costal
Retractor or operating
trocar, 8-12mm
Mid-scapular line below
the 12th rib
 30⁰
 Atraumatic graspers
 Ultrasonic dissectors
 Linear Stapler
 L-hook Electrocautary tool
 Flexible retractor
 Suction-irrigation device
 Specimen retrieval bag
 Spleen scoop
Check for mobility
of the spleen and
location of possible
00:00- 6:40
Dissection of the
ligament with the
harmonic scalpel.
6:40- 8:43 & 18:3023:20
Dissection of the
9:14- 13:53
Check for and
remove any
attachments to the
abdominal wall.
13:53- 15:42
Exposure and
transection of the
tissue and vessels in
the gastrosplenic
23:20- 28:30
An L hook cautery is
used to dissect
some of the
28:30- 31:32
 Drainage
of Cyst
Locate and drain
the splenic cyst
32:40- 42:20
Dissection of the
splenorenal ligament.
42:20- 46:27
 Careful dissection of
the splenic hilum.
46:27- 56:45
 Identify and staple
the splenic artery.
56:45- 1:02:03
 Identify and staple
the splenic vein.
1:02:03- 1:02:50
 Detachment
Fully detach the
spleen by removing
any remaining
1:02:50- 0:40 (2)
 Extraction
A bag is introduced in
the retraction trocar.
3:30 (2)
Insert the spleen in
the bag and close.
3:30- 19:20 (2)
 Pull the tip of the bag
up through the
retraction trocar.
31:20 (2)
 The bag is cut away
from the rim.
 The spleen is
morcellized with
spleen scoops and
 Closure
Check for tissue
damage and
accessory spleens
00:00- 5:31 (3)
 Liquid
diet- the night of or the morning after
 Regular diet and discharge from the hospital
by the second postoperative day
 Within two weeks, patients are usually able
to return to work
 Steroid dosages can be tapered rapidly and
then discontinued
 Intraoperative
Uncontrollable bleeding
Injury to regional organs during dissection
More common with larger spleens
 Postoperative
Minor wound infections
Postoperative ileus
 ITP:
Recurrent or persistent decrease in the number
of blood platelets
Chronic ITP
 Curative
in about 50-60 percent of patients
 Improves another 20-35 percent
 Fails to help 5-10 percent
 Primary
benefit of laparoscopic is several
small incisions instead of one large incision
Shorter hospital stay
Quicker recovery
Better cosmetic result
 Laparoscopic
procedure is a more demanding
Highly vascularized organ
Fragile parenchyma
Attached by several ligaments to other organs
Hematological disease often associated with a
low platelet count
Targarona, EM. (2002, March). Laparoscopic splenectomy:
anterior posterior approach. Retrieved from
The University of Texas Southwestern Medical Center at
Dallas. (2010). Laparoscopic spleen surgery. Retrieved
Adas, G, et al. (2009). Diagnostic problems with parasitic
and non-parasitic splenic cysts. BMC Surgery , 9(9),
Retrieved from doi: 10.1186/1471-2482-9-9
Kalinova K. (2005). Giant pseudocyst of the spleen: A case
report and review of the literature. Journal of Indian
Association of Pediatric Surgeons, 10(3), Retrieved from

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