Anatomical considerations during Laparoscopic excision of a splenic cyst: case report

A 58 year old female presented with a vague aching type persistent epigastric and left hypochondrial pain for two months. There was no history of abdominal trauma. General and abdominal examinations were normal. Ultrasound scan revealed a unilocular thin walled encapsulated cyst in the lower pole of spleen measuring 7.9cm x 7.1cm x 5.9cm suggestive of a benign cyst. Contrast CT abdomen confirmed an encapsulated unilocular thin walled cyst at lower pole of the spleen. Laparoscopic splenic cyst excision was planned after obtaining informed consent. As the spleen and cyst occupies the left hypochondrium patient was placed on right lateral decubitus position and head up tilt to let other organs fall away from field of dissection. With stomach's close relationship with the spleen decompression of stomach with a nasogastric tube facilitates dissection. Surgery was performed using three ports. After inserting the camera port related anatomy was appreciated. Stomach, spleen, transeverse colon, splenic flexure, gastro-splenic ligament, gastro-colic ligament and spleno-colic ligament were identified. As the cyst was large it was initially decompressed by aspiration. Excision of the cyst with a thin rim of splenic tissue was done using ultra-sonic dissector and bipolar diathermy. Hilar area with splenic vasculature was preserved. The specimen was retrieved within a retrieval bag through enlarged 10mm port site. The surgery was completed in 45 minutes without any measurable blood loss.