Laparoscopic splenectomy for massive splenomegaly using a Lahey bag

Background: Although the recent development of hand-assisted laparoscopic s urgery (HALS) has made the laparoscopic retraction of large spleens feasibl e, the laparoscopic removal of massively enlarged spleens (> 1,000 g) remai ns a significant problem because these spleens do not fit into endoscopic b ags. Consequently, in order to remove massive spleens either a large abdomi nal incision or morcellation of the spleen outside of an endoscopy bag is r equired. Methods: Two patients, with spleens weighing 2.510 g and 1.720 g, under-wen t laparoscopic splenectomy using a hand port to ensure safe retraction. The massive spleen was placed into a Lahey bag that was inserted into the abdo men through the hand port site. While in the Lahey bag, the spleen was remo ved piecemeal through the hand port site. Results: Both operations were completed laparoscopically without complicati ons. The patients were discharged on postoperative day 2 and experienced mi nimal morbidity. Conclusions: The Lahey bag facilitates laparoscopic splenectomy for massive splenomegaly as even the most massive spleens will fit into a Lahey bag. A massive spleen may be removed piecemeal from the Lahey bag through the sma ll hand port incision without risking a large abdominal incision, splenosis , or the insertion of a morcellator. (C) 2001 Excerpta Medica, Inc. All rig hts reserved.