title: Laparoscopic splenectomy: the latest technical evaluation.
abstract: OBJECTIVE
  To introduce our latest innovation on technical manipulation of laparoscopic splenectomy.
  
  
  METHODS
  Under general anesthesia and carbon dioxide (CO(2)) pneumoperitoneum, 86 cases of laparoscopic splenectomy (LS) were performed. The patients were placed in three different operative positions: 7 cases in the lithotomic position, 31 cases in the right recumbent position and 48 cases in the right lateral position. An ultrasonic scissors was used to dissect the pancreaticosplenic ligament, the splenocolicum ligament, lienorenal ligament and the lienophrenic ligament, respectively. Lastly, the gastrosplenic ligament and short gastric vessels were dissected. The splenic artery and vein were resected at splenic hilum with Endo-GIA. The impact of different operative positions, spleen size and other events during the operation were studied.
  
  
  RESULTS
  The laparoscopic splenectomy was successfully performed on all 86 patients from August 1997 to August 2002. No operative complications, such as peritoneal cavity infection, massive bleeding after operation and adjacent organs injured were observed. There was no death related to the operation. The study showed that different operative positions could significantly influence the manipulation of LS. The right lateral position had more advantages than the lithotomic position and the right recumbent position in LS.
  
  
  CONCLUSIONS
  Most cases of LS could be accomplished successfully when patients are placed in the right lateral position. The right lateral position has more advantages than the conventional supine approach by providing a more direct view of the splenic hilum as well as other important anatomies. Regardless of operation positions, the major axis of spleen exceeding 15 cm by B-ultrasound in vitro will surely increase the difficulties of LS and therefore prolong the duration of operation. LS is a safe and feasible modality for splenectomy.
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China. tommyt@vip.163.com
authors.forename: Min
authors.initials: M
authors.lastname: Tan
authors.forename: Chao-Xu
authors.initials: CX
authors.lastname: Zheng
authors.forename: Zhi-Mian
authors.initials: ZM
authors.lastname: Wu
authors.forename: Guo-Tai
authors.initials: GT
authors.lastname: Chen
authors.forename: Liu-Hua
authors.initials: LH
authors.lastname: Chen
authors.forename: Zhen-Xian
authors.initials: ZX
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000075202:Contraindications; D005260:Female; D006402:Hematologic Diseases / Q000473:pathology / Q000601:surgery; D006801:Humans; D006971:Hypersplenism / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000473:pathology / Q000601:surgery; D013163:Splenomegaly / Q000473:pathology / Q000601:surgery