Background: A variety of approaches have been proposed for laparoscopic splenectomy, including the
anterior approach, the lateral approach (hanging spleen technique), and the semilateral approach (leaning
spleen technique). We advocate a leaning spleen approach with early ligation of the splenic artery.
Materials and Methods: Since 1997, we have performed 120 laparoscopic splenectomies using the
leaning spleen approach along with early ligation of the splenic artery. The patient is placed in a
70-degree semi-right lateral position. The operative steps are: exposure of the lesser sac, control of
the splenic artery, mobilization of the splenic flexure, division of the splenocolic ligament, division
of the splenophrenic ligament, hilar mobilization, mobilization of the upper pole of the spleen, and
removal of the specimen.
Results: The most common indication for surgery was autoimmune hemolytic anemia (35.8%).
One patient had severe perisplenitis with extensively vascularized adhesions, which led to oozing
during surgery obscuring the laparoscopic view, requiring conversion to open surgery. The mean
spleen diameter was 22.8 cm (range, 12.5–37.0 cm) on imaging. The mean operative time was 85
minutes (range, 54–124 minutes). Concomitant laparoscopic cholecystectomy for pigment stone
cholelithiasis was performed in 8.3% of the patients. Accessory splenic tissue was found in 4.2%.
The average hospital stay was 3 days (range, 1–6 days). There were no significant postoperative
complications. The average follow-up has been 5.4 years (range, 1 month–9 years).
Conclusion: In adopting the modification of early ligation of the splenic artery in the leaning
spleen approach, we believe we have helped to advance laparoscopic splenectomy.
