[Laparoscopic splenectomy revisited]

We present a new technique for laparoscopic splenectomy which allows manual control of endoscopic dissection. After induction of pneumoperitoneum and insertion of an endoscope to check the absence of any contraindications, an incision is made for insertion of the hand and forearm. An airtight system allowing insertion of the hand while maintaining the pneumoperitoneum is fixed around the incision. A second port is inserted in the left flank. The procedure is then performed with laparoscopic instruments while the left hand allows for spleen mobilisation and easier exposure of the structures to be dissected and divided. Eight patients with a mean age of 51.3 years have been operated on for Idiopathic Thrombocytopenia. The average duration of the procedure was 90 min (80-130 min). No postoperative complication occurred. The mean duration of stay was 3.8 days (3-7 days). These results of this technique are encouraging. The procedure is quicker and safer than an exclusive laparoscopic approach. The incision allows removal of the intact spleen. Other applications of this system can be envisaged.