How to Preserve the Spleen: Laparoscopic Partial Splenectomy as a Treatment for Splenic Hemangioma

Summary

The surgical protocol describes a laparoscopic partial splenectomy protocol in a 30-year-old female with a splenic hemangioma. The minimally invasive, organ-preserving procedure resulted in minimal blood loss, no complications, and preserved residual spleen perfusion, offering a reproducible approach for benign splenic lesions.

Abstract

Advances in understanding splenic function and the implementation of precision medicine and enhanced recovery after surgery (ERAS) have established laparoscopic partial splenectomy (LPS) as the preferred surgical approach for benign splenic diseases, hematologic diseases involving the spleen, and minor splenic trauma. This technique not only preserves splenic function but also offers advantages, including safety, reduced postoperative pain, and accelerated recovery. The widespread adoption of LPS represents an evolving trend in splenic surgery. A case of a 30-year-old female patient with a splenic hemangioma is presented. Computed tomography (CT) angiography revealed a bifurcated splenic artery. This protocol demonstrates the key steps of a laparoscopic partial splenectomy, with a detailed focus on approach selection, vascular management, parenchymal transection, and wound closure, all performed uneventfully with minimal intraoperative blood loss. Follow-up ultrasonography demonstrated a well-perfused residual spleen. This case highlights the importance of precise preoperative vascular imaging and careful hilar dissection to ensure adequate perfusion of the residual spleen. The stepwise protocol presented here may serve as a practical reference for surgeons performing spleen-preserving laparoscopic procedures.

Introduction

Splenic hemangioma is a common benign tumor of the spleen, predominantly of the cavernous type, followed by capillary hemangioma¹. It has a female predominance, potentially associated with hormonal changes during pregnancy or oral contraceptive use². Splenic hemangiomas exhibit slow growth, yet 2%–10% have a predisposition to spontaneous rupture, potentially leading to massive intra-abdominal hemorrhage and hemorrhagic shock¹. Consequently, precise diagnosis and appropriate management are essential to reduce the risk of rupture and prevent serious complications. With advancements in laparosc....

Protocol

Informed consent was obtained from the patient. All procedures performed were in accordance with the ethical standards of the People's Hospital of Ningxia Hui Autonomous Region committee.

1. Pre-surgical steps

1. Anesthesia and positioning
   1. Administer general anesthesia with endotracheal intubation and position the patient supine.
2. Surgeon positioning
   1. Position the surgeon and camera operator on the patient's right side.
   2. Position the assistant on the patient's left side.
3. Trocar placement (A five-port approach)
   1. Pl....

Results

Preoperative contrast-enhanced CT revealed a well-defined lesion located at the inferior pole of the spleen (Figure 1). Intraoperatively, the splenic artery and its branches were successfully identified and selectively ligated (Figure 2).

Following vascular control, parenchymal transection was performed. The total operative time was 230 min, with an estimated intraoperative blood loss of 300 mL. The patient resumed oral intake on post.......

Discussion

As an indispensable organ, the spleen participates in vital functions such as regulating circulating blood volume, filtering blood, producing various immunoglobulins, and modulating the endocrine system¹¹. Historically, due to limited understanding of splenic function and anatomy, clinicians frequently performed total splenectomy for benign splenic tumors and splenic trauma. Postoperative patients face significantly increased risks of thrombocytosis, pylephlebitis, intra-abdominal abscesses, OPSI,.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
3D laparoscope	KARL STORZ SE & Co. KG	26605BA	Visualization system
Absorbable ligation clips	Hangzhou Sunstone Technology Co.,Ltd	K12	Vessel ligation
Laparoscopic instruments	Tonglu Youshi Medical Equipment Co., Ltd		Includes graspers, scissors, etc.
Latex T-shape Catheter	Zhenjiang Star Enterprise Co.,Ltd	16 Fr	Drainage catheter
Reusable Laparoscopic Bipolar Electrosurgical Forceps	Hangzhou Kangji Medical Instrument Co., Ltd.		Electrosurgical instrument
Ultrasound knife	Johnson & Johnson		Energy device for tissue dissection