Laparoscopic Splenectomy: A Minimally Invasive Approach to Spleen Removal

Introduction
Laparoscopic splenectomy has become the gold standard for elective removal of the spleen, replacing open techniques due to its advantages in postoperative recovery, reduced blood loss, and shorter hospital stay. Introduced in the early 1990s, this procedure is now widely accepted for both benign and malignant hematologic conditions affecting the spleen.

Indications

Laparoscopic splenectomy is commonly indicated for:

• Idiopathic Thrombocytopenic Purpura (ITP) refractory to medical therapy

• Hereditary spherocytosis

• Autoimmune hemolytic anemia

• Hodgkin’s and Non-Hodgkin’s lymphoma

• Splenic cysts or hydatid cysts

• Hypersplenism

• Isolated splenic trauma (select cases)

Patient Selection & Preoperative Preparation

Preoperative imaging (usually contrast-enhanced CT) is vital to assess spleen size, accessory spleens, and vascular anatomy. All patients should receive vaccinations against encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis at least two weeks prior to elective surgery.

Surgical Technique

1. Patient Positioning

The patient is placed in a right lateral decubitus position with the left side up at 45 degrees. The left arm is suspended to increase working space.

2. Port Placement

A supraumbilical camera port is used for the telescope. Additional 5mm working ports are placed in the left subcostal region and left midclavicular line. In case of massive splenomegaly, an accessory port may be required.

3. Dissection and Mobilization

• The splenocolic ligament is divided to mobilize the lower pole.

• The splenorenal and splenophrenic ligaments are dissected next.

• The short gastric vessels are controlled using harmonic scalpel or Ligasure.

4. Hilar Control

The splenic hilum is carefully approached and skeletonized. The splenic artery and vein are individually clipped or stapled. Energy devices may be used for smaller branches. Special attention is needed to avoid injury to the pancreatic tail.

5. Retrieval

The spleen is placed in an endoscopic retrieval bag and morcellated inside the bag if necessary, then extracted through the umbilical port. Any accessory spleens should be identified and removed.

Postoperative Care

Patients typically recover faster than with open surgery. Most can be discharged within 24–48 hours. Follow-up includes platelet monitoring and long-term prophylaxis against infections.

Advantages of Laparoscopic Splenectomy

• Minimal access with reduced postoperative pain

• Lower incidence of wound infection and hernia

• Early mobilization and discharge

• Better cosmetic outcome

• Enhanced visualization of splenic hilum and vascular control

Challenges and Limitations

• Difficult in massive splenomegaly (>1000 grams)

• Requires advanced laparoscopic skill

• Risk of intraoperative hemorrhage

• Requires experience in hilar dissection and vessel control

Conclusion

Laparoscopic splenectomy has proven to be a safe and effective method for spleen removal in appropriately selected patients. With advances in surgical energy devices and techniques, it continues to evolve as the preferred modality in the field of Minimal Access Surgery. Surgeons must be adept in anatomical orientation, energy application, and handling intraoperative complications to achieve optimal outcomes.