title: Early ligation of the splenic artery in the leaning spleen approach to laparoscopic splenectomy.
abstract: BACKGROUND
  A variety of approaches have been proposed for laparoscopic splenectomy, including the anterior approach, the lateral approach (hanging spleen technique), and the semilateral approach (leaning spleen technique). We advocate a leaning spleen approach with early ligation of the splenic artery.
  
  
  METHODS
  Since 1997, we have performed 120 laparoscopic splenectomies using the leaning spleen approach along with early ligation of the splenic artery. The patient is placed in a 70-degree semi-right lateral position. The operative steps are: exposure of the lesser sac, control of the splenic artery, mobilization of the splenic flexure, division of the splenocolic ligament, division of the splenophrenic ligament, hilar mobilization, mobilization of the upper pole of the spleen, and removal of the specimen.
  
  
  RESULTS
  The most common indication for surgery was autoimmune hemolytic anemia (35.8%). One patient had severe perisplenitis with extensively vascularized adhesions, which led to oozing during surgery obscuring the laparoscopic view, requiring conversion to open surgery. The mean spleen diameter was 22.8 cm (range, 12.5-37.0 cm) on imaging. The mean operative time was 85 minutes (range, 54-124 minutes). Concomitant laparoscopic cholecystectomy for pigment stone cholelithiasis was performed in 8.3% of the patients. Accessory splenic tissue was found in 4.2%. The average hospital stay was 3 days (range, 1-6 days). There were no significant postoperative complications. The average follow-up has been 5.4 years (range, 1 month-9 years).
  
  
  CONCLUSIONS
  In adopting the modification of early ligation of the splenic artery in the leaning spleen approach, we believe we have helped to advance laparoscopic splenectomy.
authors.affiliation: Gem Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: Chinnasamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Jani
authors.forename: Vijaykumar
authors.initials: V
authors.lastname: Malladi
authors.forename: Roshan
authors.initials: R
authors.lastname: Shetty
authors.forename: Rangasamy
authors.initials: R
authors.lastname: Senthilkumar
authors.forename: Gobi
authors.initials: G
authors.lastname: Maheshkumar
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000601:surgery; D002408:Catheters, Indwelling; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000601:surgery; D044684:Colon, Transverse / Q000601:surgery; D004443:Echinococcosis / Q000601:surgery; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery; D013103:Spherocytosis, Hereditary / Q000601:surgery; D013156:Splenectomy / Q000295:instrumentation / Q000379:methods*; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery; D013163:Splenomegaly / Q000601:surgery; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color