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Laparoscopic splenectomy is established in the surgical management of immune thrombocytopenic purpure (ITP). Laparoscopic extraction of the fully mobilised spleen using digital morcellation within a polyurethane bag can be tedious and frustrating. A new technique using blunt suction curettage is described.
Laparoscopic splenectomy for ITP is performed in the left lateral position. The fully mobilised spleen is retrieved using an Endocatch II polyurethane bag (Ethicon, USA) through a 15-mm port. The splenic capsule is then incised using scissors. A 10-mm round-tip disposable Karman curette (Fig. 1; Luneau, France), usually used for transvaginal endometrial suction curettage, attached to either a variable suction device or wall suction is used to curette and aspirate the intracapsular splenic fragments. The curette contains two apertures through which controlled aspiration of the splenic parenchyma can occur. Ultimately, a few small splenic fragments together with the capsular remnants persist and are easily extracted using sponge-holding forceps. The duration of the extraction procedure is usually no more than 2–3 min (Fig. 2).
While laparoscopic splenectomy has gained popularity as the preferred method of elective splenectomy for ITP, the individual steps should be continually reviewed and refined. In our experience, the use of a blunt disposable curette appears to be a safe and reliable method of splenic extraction during laparoscopic splenectomy. Variable suction allows for the initial use of low pressure to aspirate splenic pulp, although pressures up to –60 kPa (–40 l/min) can be used safely. This technique is inexpensive, expedient and aesthetically desirable.