STEP 2Exposing the entire hilum and ligating appropriate arteries

The next step involves exposure of the entire hilum of the spleen close to the parenchyma. The gastrosplenic and splenorenal ligaments need to be separated while preserving the blood supply to both poles. There is a fairly avascular area of this ligament that needs to be opened between the short gastric vessels to the superior pole and the gastroepiploic branches to the lower pole. This will lead to a complete display of the entire splenic blood supply including both poles.

Selected arterial branches then need to be tediously dissected as close to the spleen parenchyma as possible, noting that the veins are situated posteriorly in close proximity.

The vessels can be doubly ligated, transfixed or clipped. The long slender laparo-scopic clip appliers can be used for this step of the procedure. Once the arterial blood supply is controlled, the affected spleen will visibly demarcate rapidly. If the devitalized spleen corresponds to the intended resection, a similar technique is used on the venous side. Access to the venous side can also be achieved from the posterior aspect of the spleen (as indicated in illustration).

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