Begin by using a vessel sealing system to dissect the gastro splenic ligament along the greater curvature of the stomach entering the lesser sac. Then grasp the stomach and move it to the upper right for better exposure to the surgical field. Meticulously dissect the main trunk of the splenic artery at the superior edge of the pancreas and temporarily occlude it with a bulldog clip.
Now dissect the para splenic ligaments, including the spleenocolic, spleenorenal, and spleenophrenic ligaments. To perform temporary occlusion of the splenic hilum, expose it by resecting the attachments around it with an ultrasonic scalpel. Using a bulldog clip, implement a temporary occlusion of the splenic hilum.
Afterward, conduct a thorough reassessment of the spleen's color, size, and texture following occlusion. To perform intraoperative ultrasound to identify the boundary of the lesion, apply electrocautery to mark the demarcation line at least one centimeter away from the lesion. For spleen parenchyma dissection, insert a bipolar radiofrequency device into the splenic parenchyma along the demarcation line for coagulation and ablation.
Next, use an ultrasonic scalpel to dissect the splenic parenchyma in the necrotic coagulation zone. Securely clamp thick ducts using hemolock vascular clips, and then carefully cut them. To remove the specimen, release the bulldog clip ensuring no bleeding from the splenic cut edge and confirm adequate blood supply to the remnant spleen.
After cauterizing, the splenic cut edge, apply absorbable hemostatic agents over it. Afterward, position a drain tube in the splenic fossa. Place the specimen into a specimen bag.
