Laparoscopic splenectomy for massive splenomegaly using a Lahey bag.
BACKGROUND
Although the recent development of hand-assisted laparoscopic surgery (HALS) has made the laparoscopic retraction of large spleens feasible, the laparoscopic removal of massively enlarged spleens (>1,000 g) remains a significant problem because these spleens do not fit into endoscopic bags. Consequently, in order to remove massive spleens either a large abdominal incision or morcellation of the spleen outside of an endoscopy bag is required.


METHODS
Two patients, with spleens weighing 2,510 g and 1,720 g, underwent laparoscopic splenectomy using a hand port to ensure safe retraction. The massive spleen was placed into a Lahey bag that was inserted into the abdomen through the hand port site. While in the Lahey bag, the spleen was removed piecemeal through the hand port site.


RESULTS
Both operations were completed laparoscopically without complications. The patients were discharged on postoperative day 2 and experienced minimal morbidity.


CONCLUSIONS
The Lahey bag facilitates laparoscopic splenectomy for massive splenomegaly as even the most massive spleens will fit into a Lahey bag. A massive spleen may be removed piecemeal from the Lahey bag through the small hand port incision without risking a large abdominal incision, splenosis, or the insertion of a morcellator.
Greene
A K
AK
Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
Hodin
R A
RA
D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery*