[Laparoscopic splenectomy: first experiences with a 3-trocar-technique and the 'hanging-spleen-maneuver']

Laparoscopic splenectomy has been established as standard procedure for elective splenectomy and is performed for a variety of haematological diseases. However, different techniques have been used and a four- to five trocar technique is applied in most instances. We report our experience with a three-trocar technique using the triangular liver retractor and the so-called "hanging spleen" maneuver.

Data were obtained from a prospectively collected computer database of all patients who underwent elective laparoscopic splenectomy between April 2001 and July 2003.

The study population consisted of 26 patients (14 men, 12 women, mean age: 45 years; range: 16-75 years). Median operative time was 140 min (85-310 min). There was one conversion (3.8 %) due to a suspected malignancy, which was finally not confirmed. A fourth trocar had to be placed in two cases (10 %) due to a large left lobe of the liver. In two patients a small midline incision was made to extract the spleen in toto for pathohistological examination due to a splenic metastasis. In the remaining cases the spleen was morcellated in an endobag. Accessory spleens were found in 1 patient (3.8 %). There were two bleedings following operation, which required laparotomy in one patient. There were no deaths (0 %). The median postoperative hospital stay was 7 days (range 3-17).

Laparoscopic splenectomy can be performed safely in the vast majority of patients. The described technique using three trocars with the so-called "hanging spleen" maneuver can be used in about 90 % of cases.