Port placement splenectomy*

An open technique is used to enter the peritoneal cavity at the umbilicus (enlarged spleen) or in the subcostal location (normal-sized spleen). A 5 to 12 mm Hasson trocar is placed. A port is placed in the left flank region in the anterior axillary line between the left subcostal margin and the left iliac crest. This port is used to pass a stapler to transect the hilar vessels after dissection has been completed. Two additional 5 mm ports are placed for dissection and counter-traction. After the hilum has been transected and the perisplenic attachments divided, the spleen is captured into a large laparoscopic bag placed through the primary port site and removed by morselization (cutting it up). Alternatively, if the integrity of the spleen is important for pathologic analysis, a mini-laparotomy is performed.