Laparoscopic Aneurismectomy with Direct Reconstruction of the Splenic Artery and Spleen Preservation

Laparoscopic repair of splenic artery aneurism was firstly reported in 1993 and has replaced open procedures when an endovascular treatment is not possible. Authors here describe a laparoscopic splenic artery aneurismectomy with end to end reconstruction and spleen preservation in a female patient of childbearing age. Equipment: 30 degrees laparoscope; laparoscopic instruments, including ultrasonic scissor; 5 ports (2 of 12mm and 3 of 5mm); vessel loops, two clamps; hem-o-locks and clips; one 0 monofilament suture for lift of the stomach and two 6/0 monofilament suture to end to end reconstruction; endobag for specimen removal. Tips, tricks and pitfalls: Reconstruction of the splenic artery should be done by a surgeon comfortable with the anatomy and with laparoscopic skills. Mobilization and lift of the stomach is essential to perform the surgery in good conditions and avoid iatrogenic injuries. Complete dissection of the aneurism and all ramifications is necessary to avoid any uncontrolled bleeding. Use of laparoscopic vascular clamps is required to avoid arterial damage. Splenectomy is avoided thanks to the vascular reconstruction and preservation of short gastric vessels and intrapancreatic network.