[Laparoscopic splenectomy. The "hanging spleen technique" in a series of nineteen cases]

We have used an new patient position for laparoscopic splenectomy: the patient is placed in the right lateral supine position on a "bean bag" positioning apparatus and the left arm is elevated. The operator stands to the patient's right, the first assistant is on the patient's right and the second is on the patient's left. This position provides very good exposure of the spleen, which hangs from the diaphragm by the peritoneal attachments and the inferior pole splenic vessels, short gastric vessels and splenic hilus vessels can be released successively. We have now performed 19 splenectomies using the "Hanging Spleen Technique" with three conversions to open surgery. Splenectomy was always possible with the use of a plastic bag through the 12 mm trocar hole in 12 cases and through this enlarged hole in 2 cases. The mean post-operative stay was 4.3 days and the mean time to return to work was 19 days. Laparoscopic splenectomy is a feasible and safe procedure with this patient position. Obesity and splenomegaly are no longer absolute contra-indications.