title: Use of a laparoscopic hand-assist device for accessory splenectomy.
abstract: BACKGROUND
  The use of a laparoscopic hand-assist device may aid in the identification of accessory spleens (ASs) and provide similar benefits to a conventional laparoscopic procedure. A patient with previous splenectomy for immune thrombocytopenic pupusa (ITP) and recurrent thrombocytopenia is reported.
  
  
  METHODS
  A computed tomography scan and RBC scan identified several nodules consistent with ASs. Initial laparoscopic exploration could not identify all the ASs seen on preoperative imaging. A hand-assist device was placed and a total of five nodules of splenic tissue were identified without conversion to laparotomy.
  
  
  RESULTS
  The patient had a brief and uncomplicated postoperative course with a return of platelet counts to 350,000 at 1-month follow-up.
  
  
  CONCLUSIONS
  We propose that in the scenario of recurrent ITP following laparoscopic splenectomy, repeat laparoscopy is the first step once an AS is identified by preoperative imaging. If the AS is not identified at laparoscopy, the insertion of a hand-assist device is an alternative to a full laparotomy.
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors.forename: G K
authors.initials: GK
authors.lastname: Kaban
authors.forename: D R
authors.initials: DR
authors.lastname: Czerniach
authors.forename: R A
authors.initials: RA
authors.lastname: Perugini
authors.forename: Y W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: J J
authors.initials: JJ
authors.lastname: Kelly
authors.forename: D E M
authors.initials: DE
authors.lastname: Litwin
mesh_terms: D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006225:Hand; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010173:Palpation; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D013154:Spleen / Q000002:abnormalities* / Q000601:surgery; D013156:Splenectomy / Q000295:instrumentation* / Q000379:methods; D013921:Thrombocytopenia / Q000209:etiology