Abstract
Partial splenectomy allows preserving immune function in benign splenic lesions such
as epidermoid cysts. Determining the plane of resection and perfusion of the spleen
remnant can be difficult, especially in centrally located lesions. We present a 13-year-old
girl with a symptomatic splenic cyst of 6 cm in diameter located next to the splenic
hilum. Laparoscopic partial splenectomy was performed through a 10-mm umbilical approach
and three accessory 5-mm ports. Intraoperative intravenous injection of indocyanine
green (ICG) at 0.2 mg/kg guided the careful dissection of the splenic hilum and checked
the spleen perfusion once the upper arterial branch was clamped. The subsequent wash-out
of the ICG allowed inspection of the peripheral vascular return of the splenic remnant
through polar veins. Surgery was uneventful with minimal blood loss. Follow-up ultrasound
scan revealed a well-perfused small splenic remnant with no signs of recurrence.
Laparoscopic partial splenectomy is feasible in benign splenic tumors, especially
in those cases of peripheral location. Fluorescence facilitates the safe dissection
of the splenic hilum, the visualization of the transection plane of the spleen and
the perfusion of the remnant in cases of anatomically and technically complicated
partial splenectomies.
Keywords
partial splenectomy - laparoscopy - fluorescence - indocyanine green - pediatric
