title: Safe approach to the splenic hilum by first mobilizing the pancreatic tail in laparoscopic splenectomy.
abstract: BACKGROUND
  We employed a safe approach during laparoscopic splenectomy by first mobilizing the pancreatic tail and then dissecting the splenic vessels at the splenic hilum before mobilizing the spleen.
  
  
  METHODS
  Patients were placed in the lithotomy position, and only the upper body was twisted to the right side. Five trocars were placed. After the bursa omentalis was opened, an avascular layer was identified behind the pancreas. This avascular layer was bluntly dissected, and the pancreatic tail was isolated from the retroperitoneum. The tissue surrounding the splenic hilum was dissected by a handling tape that was placed around the pancreatic tail. Because the spleen remained connected to the retroperitoneum with the splenorenal ligament, a good operative view of the splenic hilum was obtained with proper extension. After sufficient space was secured between the pancreatic tail and the spleen, the splenic vessels were divided with a linear stapler. The spleen was detached in the final stage.
  
  
  CONCLUSIONS
  The current standardized procedure is highly recommended for a safe laparoscopic splenectomy.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Honda
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Masanao
authors.initials: M
authors.lastname: Kurata
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Homma
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shinya
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Honjo
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010179:Pancreas / Q000601:surgery*; D013154:Spleen / Q000098:blood supply / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery*; D016896:Treatment Outcome
keywords: Laparoscopic surgery; pancreas; splenectomy