Laparoscopic Partial Splenectomy for Splenic Cyst

The cyst was an epidermoid cyst of the spleen measuring more than 10 centimeters in greatest diameter in the upper pole.

The cyst was discovered on ultrasound performed for abdominal pain in a 14 year old girl.

Port placement uses 2 five-millimeter ports and 2 ten-millimeter ports, with the camera at umbilicus, superiormost epigastric port for retraction, and mid-epigastric and left lower quadrant ports for working instruments.

The use of 2 ten-millimeter ports allows for a 10 millimeter energy device to be deployed parallel or perpendicular to the splenic axis as needed.

All 3 midline port incisions are oriented vertically so that they can be included in a midline incision if conversion is necessary.

The patient is positioned on a bean bag in a partial left lateral decubitus position, as is used for a laparoscopic splenectomy.

The short gastric vessels are divided in order to devascularize the superior pole of the spleen containing the cyst.

The cyst closely approaches the hilum, requiring division of a hilar branch vessel.

The 10 millimeter ligature device is preferred for splenic transection because it compresses the tissues more securely and is less likely to simply fracture the spleen.

Despite devascularization and despite using an energy device, a fair amount of bleeding should be expected during transaction.

A suction device should be used to evacuate the blood intermittently as the transaction progresses.

The raw surface of the spleen is cauterized using spray coagulation set at 30 to 40 watts.

It is important to confirm complete hemostasis of the splenic surface.

A large sheet of Surgicel is draped over the raw surface of the spleen and an omental pedicle is brought to the vicinity of the same surface.