title: Exposure of splenic hilum increases safety of laparoscopic splenectomy.
abstract: Laparoscopic splenectomy is becoming the gold standard technique for the treatment of hematological disorders of the spleen. Hemostasis is a fundamental step during laparoscopic splenectomy leading some authors to develop several techniques to control splenic vessels such as hand assistance, preoperative splenic artery embolization, and the use of vascular linear staplers. However, intraoperative bleeding is usually due to inadequate exposure of the hilar splenic vessels itself. The authors describe a standardized technique for the exposure of splenic pedicle using an endoscopic triangular retractor. We have been used this technique in 16 consecutive laparoscopic splenectomies with minimal blood loss. The present technique may increase the safety of laparoscopic splenectomy with adequate exposure of the splenic hilum reducing the conversion rate and intraoperative blood loss.
authors.affiliation: Department of Abdominal Surgery, Cancer Hospital, São Paulo, Brazil. dr@drmarcel.com.br
authors.forename: Marcel Autran C
authors.initials: MA
authors.lastname: Machado
authors.forename: Fábio F
authors.initials: FF
authors.lastname: Makdissi
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.forename: André L
authors.initials: AL
authors.lastname: Montagnini
authors.forename: Rubens A A
authors.initials: RA
authors.lastname: Sallum
authors.forename: Marcel C C
authors.initials: MC
authors.lastname: Machado
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery; D013154:Spleen / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome