Use of Nathanson retractor during laparoscopic splenectomy for supermassive spleens.

Background: Although feasibility of laparoscopic splenectomy for supermassive spleens has been described, obtaining uniform and uninterrupted retraction of a heavy spleen to ensure safe hilar dissection is challenging. We describe a technique of retraction of supermassive spleens using a Nathanson retractor.

Methods: This technique was used in 4 patients, and the demographic data as well as data related to the surgery were retrospectively collected.

Results: The spleens weighed between 2.5 and 3.5 kg. The median operative time was 190 minutes (155-220 min) and the median intraoperative blood loss was 870 mL (600-1230 mL). The postoperative hospital stay ranged from 3 to 5 days.

Conclusions: A Nathanson retractor provides sustained retraction of a supermassive spleen during laparoscopic splenectomy and this technique should be considered a useful adjunct to the armamentarium of surgeons undertaking these challenging procedures.