Macrobiopsy of the spleen: proposal for a laparoscopic approach

The spleen plays an important role in the immune response; however, its fun ction is not yet fully understood. Splenectomy is still proposed for diagno sis in some patients with splenic focal lesions or splenomegaly. Often in t hese patients, an adequate splenic biopsy would be sufficient to obtain the correct diagnosis and address the appropriate non-surgical management. Whi le percutaneous fine needle biopsy preserves the spleen and its functions, in some instances the tissue sample obtained is inadequate for a definitive diagnosis. We report a technique of laparoscopic macrobiopsy of the spleen , performed in two patients with splenic focal lesions. It requires, as a f irst step, the clipping of the splenic artery before the origin of the left gastroepiploic artery, to reduce the risk of bleeding. Macrobiopsy of the spleen, including the focal lesion, was performed using monopolar cautering scissors. This technique provided an adequate amount of tissue for diagnos is, and it was possible to preserve the spleen.