Laparoscopic Splenectomy for Massive Splenomegaly

Introduction: This video illustrates the technical feasibility and safety of the laparoscopic approach in the setting of massive splenomegaly.
We present the case of a 37 year-old man who was referred to us after failure of medical treatment for massive splenomegaly associated with non Hodgkin B-cell lymphoma. He had been complaining of nocturia, suprapubic pressure and early satiety for one year. He also had anemia and thrombocytopenia. Despite 8 infusions of Rituximab his splenomegaly persisted. Further hematologic work-up revealed the presence of lupus anti-coagulant. Initial CT scan revealed a 33x26cm spleen. The splenic artery was prominent and seemed to be sinuous and amenable to early ligation. A small window between the liver and the spleen was evident.
Methods and Procedures: A laparoscopic splenectomy was performed with the anterior approach and early ligation of the splenic artery using a vascular TA 2.5-mm stapler. The spleen was morcellated and removed through the epigastric port.
Results: The patient tolerated the procedure well and was discharged home uneventfully on the 4th postoperative day.
Final pathology was consistent with splenic marginal zone lymphoma.
Conclusion: We conclude that laparoscopic splenectomy in massive splenomegaly is safe and feasible without needing to resort to a hand-assisted technique.

Session: Podium Presentation

Program Number: V030

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