Laparoscopic Partial Splenectomy with Linear Cutting Stapler-Assisted Parenchymal Transection: a Novel Technique.

Abstract

Laparoscopic partial splenectomy (LPS) is an effective method for resecting benign splenic lesions while maintaining physiological splenic function.^1,2 The primary surgical challenge is controlling hemorrhage during parenchymal transection. Although previous studies have highlighted the success of bipolar electrothermal devices, and microwave ablation in this phase,^3-5 we introduced a novel technique integrating ultrasonic dissection with linear stapling technology. This approach occludes major intraparenchymal vasculature during transection, improving both safety and efficiency. A 66-year-old female patient with a 7.3 cm cyst in the upper pole of the spleen underwent preoperative evaluation with computed tomography (CT) and magnetic resonance imaging (MRI). Our LPS protocol proceeded as follows: (1) splenic ligament and short gastric vessels are divided using hemlock clips, (2) anatomical identification of segmental vessels supplying the upper pole, (3) parenchymal pre-dissection along ischemic demarcation line, and (4) combined use of ultrasonic dissection and sequential stapling for parenchymal transection. The procedure was completed in 145 min with minimal blood loss (50 mL). No intraoperative complications or blood transfusions were required. The patient was discharged on the fourth postoperative day without complications. Pathological examination confirmed the complete removal of a benign mesothelial cyst. The stapler-assisted LPS technique enhances the safety and efficiency of LPS by minimizing intraoperative hemorrhage and streamlining the parenchymal transection process.