Laparoscopic splenectomy. The "hanged spleen" technique

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic splenectomy is a minimally invasive surgical technique for spleen removal.
• Optimal patient positioning is crucial for achieving adequate surgical exposure and safety during laparoscopic procedures.
• Existing patient positions may present challenges in visualizing and accessing the spleen during laparoscopic splenectomy.

Purpose of the Study:

• To introduce and evaluate a novel patient positioning technique for laparoscopic splenectomy.
• To assess the feasibility, safety, and efficacy of this new positioning method.
• To determine the impact of this position on surgical visualization and operative steps.

Main Methods:

• A modified right lateral supine position was employed, utilizing a "bean bag" apparatus.
• The patient's left arm was elevated to enhance surgical access.
• The surgical team was positioned to optimize ergonomics and visualization of the spleen and its attachments.

Main Results:

• The new position provided excellent visualization of the spleen and its peritoneal attachments.
• The technique allowed for clear identification and sequential ligation of splenic vessels (inferior polar, short gastric, and hilar).
• Out of thirteen procedures, twelve achieved successful outcomes with this method, with one conversion to laparotomy.

Conclusions:

• The described right lateral supine patient position is a feasible and safe approach for laparoscopic splenectomy.
• This technique is particularly advantageous for spleens of moderate size, offering improved operative field exposure.
• Further adoption of this positioning strategy may enhance the safety and efficiency of laparoscopic splenectomy procedures.