Shingo Ishida, MD, Masayasu Aikawa, MD, Yukihiro Watanabe, MD, Katsuya Okada, MD, Kojun Okamoto, MD, Mitsuo Miyazawa, MD, Isamu Koyama, MD. Saitama Medical University, International Medical Center
In laparoscopic splenectomy, a giant spleen is usually cut down by using an electric morcellator or is manually crushed for extracting it from the abdominal cavity. However, cases of morcellator-related injury are often noted. In cases where the spleen has a malignant lesion, blind crushing may be undesirable, to avoid the proliferation of the malignant specimen and to obtain an appropriate specimen for pathology examination. In the present report, we describe a new technique for safely extracting a giant spleen, wherein the spleen is laparoscopically divided in an extraction bag under air insufflation to the bag. A 70-year-old man with acute myelocytic leukemia exhibited a spleen that was 8 × 6 cm in size. After the first chemotherapy session, the spleen ruptured. In order to continue chemotherapy, extraction of the spleen was needed. The patient was placed in the split-leg position and general anesthesia was administered. Moreover, we placed a camera port in the umbilical region and 4 trocars in the upper abdominal region. The adhesion present around the spleen was easily released. The splenic artery and vein were divided around the splenic hilum by using a linear tri-stapler. An extraction bag (Endo Catch-II™) was inserted through the umbilical wound and into the abdominal cavity for storage of the spleen. The mouth of the bag was extracted from the abdominal cavity. Thereafter, the umbilical wound was extended by 2 cm, and a SILS port™ was placed on the mouth of the bag. An air insufflation into the bag could obtain sufficient working space to divide the spleen within the bag. The spleen was divided into five portions, which were easily extracted from the abdominal cavity without extending the wound.The total duration of the operation was 300 minutes, and the duration of extraction was 62 minutes. The extracted specimen could be used for pathological diagnosis and was confirmed to lack any leukemic cells. Furthermore, no postoperative complications were noted. The patient was discharged from the hospital 6 days after the operation and chemotherapy was attempted.Through this novel method, we could perform laparoscopic splenectomy in a safe manner for a giant spleen with malignant potential, without extending the wound size to more than 2 cm.