PMC5755232_01
Computed tomography showing a giant splenic cyst.
rjx255f01.jpg
PMC5755232_01_rjx255f01.jpg
rjx255F1
An ultrasound scan showed a large splenic cyst with no increase in vascularity on Doppler assessment, while an intravenous contrast-enhanced CT scan showed a 12.5 x 9.7 x 10.7 cm well-defined cystic mass arising from the upper pole of the spleen (Fig. 1) with multiple fine echogenic shadows and medial displacement of the stomach and the left kidney (Fig. 2).
A schematic illustration of the ports positions. The working ports are numbered 1 and 3, port 2 is for the laparoscope, while port 4 is for a 5-mm diamondflex retractor.
rjx255f03.jpg
PMC5755232_01_rjx255f03.jpg
rjx255F3
Laparoscopic surgery proceeded with four ports in the left upper abdomen (Fig. 3).
An operative image showing the splenic hilum slung with the vascular tape and clamped with a segment of a nasogastric tube.
rjx255f04.jpg
PMC5755232_01_rjx255f04.jpg
rjx255F4
The slung splenic hilum was clamped by advancing a plastic tube (a mid-section of a nasogastric tube) over the Nylon sling and fixing it in position with a haemostat applied outside the abdomen (Fig. 4). The cyst was then decompressed by aspirating its clear straw-coloured fluid content which enhanced exposure and access.
An operative image showing the splenic cyst after de-capsulation with a bloodless bed and minimal bleeding from edges of the cyst.
rjx255f05.jpg
PMC5755232_01_rjx255f05.jpg
rjx255F5
The hilum was unclamped after a total ischaemia time of 30 min and no bleeding was encountered despite reducing the intraperitoneal pressure to 7 mmHg for 3 min. The spleen appeared well perfused (Fig. 5). 