The anatomical basis for laparoscopic splenectomy.

The anatomy of the splenic blood supply is extremely variable. Two principal patterns, the distributed and the magistral types, include the majority of variations. These two types differ with respect to the length of the splenic trunk, the number of arterial branches and the proportion of the medial surface of the spleen occupied by the branches as they enter the organ. The suspensory ligaments of the spleen, including the sustentaculum lienis, are usually avascular except for the gastrocolic and lienorenal ligaments on the medial side. The tail of the pancreas touches the spleen in 30% of cases and lies within 1 cm of the spleen in 73%. Knowledge of these basic anatomic facts and the variations should contribute to the safety of laparoscopic splenectomy.