POSTEROLATERAL APPROACH - AN ALTERNATIVE STRATEGY IN LAPAROSCOPIC SPLENECTOMY

Laparoscopic splenectomy (LS) is effective and technically feasible fo r treating various hematological diseases, especially idiopathic throm bocytopenic purpura (ITP). An anterior approach to the vascular pedicl e is usually described. However, in this approach to the splenic hilum , the dissection of the splenic artery is often difficult. A total of 13 patients with ITP underwent elective laparoscopic splenectomy. We u tilized a laparoscopic posterolateral approach involving dissection of the suspensory ligaments at the lower pole, then dissection and divis ion of the posterolateral attachments, followed by the dissection and ligation of all splenic branches near the splenic parenchyma. This pro cedure was completed in 11 of our 13 patients and converted to open su rgery in the other two patients. Mean operative time was 3 h; mean pos toperative stay was 3 days. No blood transfusion was required, and no complications were noted in the postoperative period. The posterolater al approach provides better visualization and control of branches of t he splenic vein and artery in the splenic hilum. It also permits visua lization and control of surgical hemorrhage through the operating port s.