Laparoscopic splenectomy for a splenic cyst: posterior approach

This video demonstrates a posterolateral approach to splenectomy. The surgeon mobilizes the spleen towards the midline by dividing the lateral peritoneal attachments. He then proceeds to divide all the splenic attachments and vessels from inferior to superior border using a ligasure. The splenic hilar vessels are divided with linear staplers. the spleen is removed within a retrieval sac.

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Laparoscopic   splenectomy   for   a   splenic   cyst:   posterior   approach

Authors
D Mutter
Abstract
This video demonstrates a posterolateral approach to splenectomy. The surgeon mobilizes the spleen towards the midline by dividing the lateral peritoneal attachments. He then proceeds to divide all the splenic attachments and vessels from inferior to superior border using a ligasure. The splenic hilar vessels are divided with linear staplers. the spleen is removed within a retrieval sac.
Catégorie
routine cases
Mots-clés
spleen,operation,resection,laparoscopy,cyst,posterior
Type de vidéo
Durée
06'00''
Publication
2003-05
Popularité
Favoris
Favorites Media
Audio
en
Sous-titres
en
E-publication
WeBSurg.com, May 2003;3(05).
URL: http://www.websurg.com/doi-vd01en1437e.htm

Laparoscopic   splenectomy   for   a   splenic   cyst:   posterior   approach

1. Case presentation 00'15''
The patient is in a full lateral decubitus with the table angle at the flank. The surgeon stands in front of the patient and the trocars are positioned as such. The spleen leans forward because of the positioning of the patient. The 1st step of the surgery is to mobilize the splenic angle of the colon. This is done using sharp dissection with the diathermy. Then the spleen is retracted to the left to start the posterior mobilization of the spleen. The posterior and lateral attachments of the spleen are divided. The action of the assistant helps in the easy division of these attachments and using proper traction and counter-traction, the spleen progressively is mobilized and rotates in an anti-clockwise fashion towards the anterior and right part of the abdomen. We can see here the tail of the pancreas and care is taken to perform the dissection in the proper plane between the spleen and the tail of the pancreas. Care should be taken to avoid any injury of the pancreatic tail and the dissection proceeds as the posterior layer of the gastrosplenic ligament is opened. This will help to expose in this posterior fashion the gastrosplenic vessels. We can see one here. The inferior attachments of the spleen are divided now and we can appreciate now the importance of the retraction performed by the assistant. The gastrosplenic vessels are now coagulated and divided using a high frequency bipolar device and this is done well away from the tail of the pancreas. We now can see as the spleen has been rotated upwards and forward the splenic cyst and we go now to the hilum of the spleen for the dissection of the splenic vein and artery. The splenic vein is at the left of the hook right now. We can also see what appears to be an accessory spleen, which we will try to preserve. The splenic vein is here. It is completely dissected and we can see here the splenic artery, which will be separated from the splenic vein. Better exposure will be obtained by rotating the spleen posteriorly. Some last gastrosplenic attachments are divided and the dissection of the splenic vein is continued. Traction is applied on the vein to allow better control of this vessel and it is divided using the same high frequency bipolar device. We can see a bit of the accessory spleen and now this pulsating splenic artery. The spleen is pushed again upwards. The artery is dissected and divided using a vascular load of the linear stapler. Some last attachments remain and are divided as well and now the spleen and the large cyst are completely free. The spleen is placed in a retrieval sac and this concludes the procedure.