Case report. Laparoscopic splenectomy for dermoid cyst

Laparoscopic splenectomy has been described for small spleens associated with haemoiytic anaemias and idiopathic thrombocytopaenic purpura [1, 2]. We describe splenectomy for a large dermoid cyst. A large splenic cyst measuring some 12 cm by 10 cm on CT scan was treated by percutaneous drainage on two occasions but rapidly recurred in each instance. Laparoscopic removal was successfully undertaken through one 12 mm, one 10 mm and two 5 mm ports. Whilst separating dense adhesions to the underside of the diaphragm using cutting diathermy a small puncture in the diaphragm was made and a left pneumothorax developed. This was successfully repaired using a single polygalactin suture. The spleen was removed piecemeal through the 12 mm port which proved time consuming but no port extensions were required. A method for extraction of solid organs without having to unduly extend the incisions is clearly necessary. Any method which relies on piecemeal disaggregation is impractical. The puncture of the diaphragm due to the diathermy illustrates the efficacy of the cutting current and operators should avoid its use on the diaphragm.