Hybrid approach to laparoscopic decapsulation combined with splenic artery balloon occlusion in a patient with carbohydrate antigen 19-9 producing splenic cysts.

INTRODUCTION: Carbohydrate antigen 19-9 producing splenic cysts are relatively rare and usually occur in women and young individuals. This report describes the use of a novel splenic-preserving surgical approach in the hybrid operating room to reduce the risk of bleeding.

MATERIALS AND SURGICAL TECHNIQUE: A 27-year-old woman presented at our hospital with a chief complaint of chest pain. CT showed an encapsulated left pleural effusion and multiple splenic cysts. The patient was diagnosed with carbohydrate antigen 19-9-producing splenic cysts and was treated with laparoscopic decapsulation. In the hybrid operating room, a balloon catheter was positioned in the splenic artery. Four ports were inserted into the abdomen, the cysts were punctured, and intracystic fluid was suctioned out. Combined splenic artery balloon occlusion was performed to control bleeding when the cyst wall was resected near the splenic parenchyma. Occlusion was performed to create intermittent blockage and consisted of 20-min ischemia and 5-min reperfusion. Then, the inner surface of the cyst wall was cauterized. The total operation time was 170 min (laparoscopic time, 110 min), and blood loss was 100 mL. There were no intraoperative or postoperative complications. The patient has remained healthy, with no recurrence for 8 months.

DISCUSSION: Laparoscopic decapsulation for the treatment of splenic cysts can prevent life-threatening bacterial infections by preserving the spleen, but this can increase the risk of bleeding from the left splenic parenchyma. Combining splenic artery occlusion with laparoscopic decapsulation is a useful approach in the hybrid operating room.