Acute splenic trauma can be managed without operation in most patients. If this approach is not successful, open splenectomy is typically performed. The laparoscopic approach to splenectomy is usually reserved for use in the elective setting and according to some authors is contraindicated in the setting of trauma. We, however, have performed laparoscopic splenectomy in highly selected patients.

This video demonstrates our technique for laparoscopic splenectomy after trauma. The patient fell from a ladder and sustained a splenic subcapsular hematoma that was managed non-operatively. Two weeks later he presented back to the emergency room with left upper quadrant abdominal pain and repeat CT imaging revealed an enlarging subcapsular hematoma. After appropriate consent, we performed a laparoscopic splenectomy and this video details our technique. We emphasize early control of the splenic artery by ligation in the lesser sac, and subsequent mobilization using caution to avoid perforating the splenic capsule during this dissection. The hilum is divided using a stapler and the spleen placed inside a retrieval bag and morcellated for removal. No intraoperative or postoperative complications occurred and the patient was discharged home on the first postoperative day.