Lateral approach for laparoscopic splenectomy

Laparoscopic surgery has become the standard treatment for both benign and malignant diseases of the spleen that require splenectomy. Throughout the nearly last three decades, different approaches have been described since Delaitre and Maignien reported the first minimally invasive splenectomy in 1991. In general terms, indications for the laparoscopic approach are the same as for open surgery, except in traumatic cases, where the use of this approach remains controversial. The minimally invasive approach to the spleen has proven to be safe and feasible, and not only provides the already well-known advantages of this technique, but also has shown better outcomes than open surgery. Three patient-positions (anterior, semilateral, full lateral) have been described for the performance of laparoscopic splenectomy. Each of them has their advantages and disadvantages and the choice of one over the other will depend on the preferences of the surgeon. In this video we present the case of a woman affected by idiopathic thrombocytopenic purpura (IPT) refractory to pharmacological treatment who underwent a laparoscopic splenectomy in a full lateral decubitus position.