Laparoscopic partial splenectomy with selective pedicular approach (with video

An increased risk of potentially lethal infection is a major concern after total splenectomy [1]. However, it is currently demonstrated that preservation of about 25-30% of splenic parenchyma may lead to an appropriate immunological response, allowing to perform partial splenectomy [2]. These findings have led to consider partial splenectomy as possible and potentially optimal treatment for benign splenic lesions. However, few series have evaluated the role of laparoscopic approach for this indication in adults [3,4]. After a preoperative work-up including abdominal CT-scan and MRI, indications for splenic resection are symptomatic patients, when tumor diameter > 5cm, or when the diagnosis remains unclear. Because of risks of total splenectomy and postoperative splenic infarction, preoperative vaccination has been recommended. This video shows an adult patient with a cystic splenic lesion who underwent a laparoscopic partial splenectomy. During this surgical procedure, two main steps were elective dissection of sectorial vascular pedicles feeding the splenic parenchyma and splenic transection through the ischemic parenchyma using an harmonic scalpel. Both of them are clearly explicited. The specimen is taken out using a trocar incision or a sus-pubic incision, or, when the specimen is large, using a left sub -costal incision. Pathology showed a benign mesothelial splenic cyst. This video shows different steps necessary to be followed when performing a partial splenectomy with a transabdominal laparoscopic approach.