Laparoscopic splenectomy: Comparison of anterior/posterior approach

The spleen can be approached by laparoscopy through diverse patient positio ns. The most difficult step of LS is the careful liberation of the posterio r face of the spleen from the posterior attachments. Is for that question t hat the transition and evolution of LS has been associated to the increased lateral tilt of the patient till the full lateral approach. With this modi fication, a great advantage is gained from gravity and the weight of the sp leen facilitates the dissection Aim: To summarise the different alternative s for LS. Results: The techniques proposed for LS are 1.- Anterior (supine) in supine or modified lithotomy position, 2.- Lateral (Semilateral (45-60% ) or Full lateral(90 degrees). In this option, the splenic hilum is dissect ed by an antero lateral, postero lateral or with the 'hanged spleen' techni que. Finally, 'hand assisted' LS (HALS) is a new alternative for selected c ases. Conclusion: The evolution in patient position has expanded the succes s of LS. LS are the preferred treatment for cases with small spleens. Splen omegaly increases the difficulty for LS, but alternative strategies (HLAS) permit to offer the laparoscopic surgery to this specific subset of patient s.