Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly

Laparoscopically assisted splenectomy with an 8- to 10-cm left upper parame dian laparotomy was performed following preoperative splenic artery emboliz ation using painless contour emboli (super absorbent polymer microsphere) w ith early successful results in two men (46 and 37 years old) with myelofib rosis accompanied by massive splenomegaly. Dissection around the lower part of the spleen and the hilum initially was performed intracorporeally with the usual laparoscopic view under 12 mm Hg pneumoperitoneum. The alternatin g changes of viewpoints between the direct view through an 8- to 10-cm inci sion and the usual laparoscopic view with or without application of a retra ction method were effective for safe hilar devascularization. Preoperative splenic artery embolization at the distal site was effective for safe disse ction around the enlarged spleen. The patients did not complain of pain bef ore operation. Preoperative painless embolization and laparoscopically assi sted splenectomy with small laparotomy promotes the feasibility and safety of minimally invasive splenectomy for myelofibrosis with massive splenomega ly.