Laparoscopic near-total splenectomy (NTS) for splenic cyst

  • Abstract
    Symptomatic non-parasitic splenic cysts are rare in clinical practice. There is some confusion about their etiology, pathogenesis and classification as well. This video shows the laparoscopic resection of a splenic cyst.
  • 00'09" Introduction
    This video shows our preferred surgical technique for benign lesions located at the upper or lower pole of the spleen. The schematic shows the detailed anatomy of the splenic hilum with the terminal branches of both the inferior splenic artery and vein coming from the left gastro-omental vessels. The CT-scan shows a cystic lesion of the upper medial region of the spleen. The patient is positioned in a right lateral decubitus.
  • 00'45" Trocar position
    After the induction of the pneumoperitoneum with an open Veress needle technique, 4 trocars are introduced below the left costal margin: two 10-12mm ports and two 5mm ports are used.
  • 01'02" Surgical field exposure
    The operation starts with the exploration of the upper quadrants and the exposure of the medial aspect of the spleen using a gentle lateral retraction with an atraumatic grasper.
  • 01'14" Lesser sac opening and splenic artery division
    The gastrosplenic ligament and the short gastric vessels are divided. This opens the way to the lesser sac. The splenic artery is identified; it is clipped and divided using the ultrasonic scissors. The progressive dissection of the pancreatic tail is carried out from the splenic hilum using a medial to lateral approach.
  • 03'23" Splenic vein division
    The splenic vein is identified and divided between clips using the ultrasonic scissors. The area to be resected is now clearly visible by the ischemic appearance of the parenchyma.
  • 03'43" Splenic parenchyma division
    The splenic parenchyma is divided by means of the bipolar forceps and ultrasonic scissors.
  • 06'14" Splenorenal and spleno-diaphragmatic ligament division
    The splenorenal and spleno-diaphragmatic ligaments are divided, thereby freeing the lower pole of the spleen.
  • 06'42" Hemostatic glue application
    FloSeal® is applied to the stump in order to improve hemostasis of the resection margin.
  • 06'57" Specimen extraction
    The specimen is placed in a retrieval bag and extracted by enlarging one of the trocar’s incision sites. The remaining splenic parenchyma is healthy-looking, as shown on the follow-up scintigraphy.
  • Related medias
    Symptomatic non-parasitic splenic cysts are rare in clinical practice. There is some confusion about their etiology, pathogenesis and classification as well. This video shows the laparoscopic resection of a splenic cyst.