- Two 12mm & two 5mm trocars
- Two Johan fenestrated forceps
- 5mm Harmonic scalpe shears
- ATW45 vascular stapler or EndoGIA
- 12mm Haem-o-Lock clips
- Specimen retrieval bag
- 5mm suction irrigation device
- 10mm fan retractor
Position patient in modified lithotomy with slight reverse Trendelenburgh with 30 degree right sided rotation with their left arm elevated (the latter facilitates posterior dissection of the hilum and minimises the amount of splenic traction required throughout the operation). Stand on the right hand side or if you prefer between the patients legs. 12mm ports are placed in umbilicus and midclavicular line midway between costal cartilage and umbilicus 5mm ports mid way between umbilicus and sternum and just below the costal margin (mid clavicular line).
Frequent repositionings of the table facilitates visualisation of structures. Look out for accessory spleens before starting.
Open the left colic omentum and divide the short gastrics with the harmonic scalpel. Retract the splenic flexure of the colon inferiorly and to the patients right and then mobilise the splenic flexure. Divide the splenocolic ligament to mobilise the lower pole. Continue dissection posteriorly. Push the stomach to the right and look out for the pancreas.
Identify the hilum.
Dissect out the splenic vein and contol, divide using a vascular stapler. Continue with the artery - you may need several applications to take all the vessels. Do not panick if there is any bleeding. Act appropriately.
Free up the posterior attachments of the upper pole of the spleen.
Introduce retrieval bag through lateral 12mm port.
Fragment the spleen in the bag using Rampley forceps, suctioning blood as needed. Remove through the umbilical incision. Irrigate the operative field and leave a 14F drain