Laparoscopic splenectomy. The "hanged spleen" technique

We have now used a new patient position for laparoscopic splenectomy: The patient is placed in right lateral supine position on a "bean bag" positioning apparatus and the left arm is elevated. The operator is located on the right of the patient; the first assistant is on the same side and the second is on the left. We have a very good view of the spleen which is hung on the diaphragm by the peritoneal attachments, and we can sever successively inferior polar splenic vessels, short gastric vessels, and hilus splenic vessels. With this patient position, it is our opinion that laparoscopic splenectomy is feasible and safe if the spleen volume is not too large. To date, we have performed thirteen splenectomies with this procedure. We have had twelve good results and one conversion to laparotomy.