hello and welcome to the gyo surgery Series this will be the first of several different explanations of individual surgeries that we perform in gainonc including some photos that I'll have referenced as well as some handmade drawings the first surgery that we'll be going over is the splenectomy and I only own the drawings other pictures will be referenced on individual slides and at the end this is for educational purposes only this is not intended to be medical advice so reference this lovely picture on the right uh the removal of the spleen is occasionally required to achieve optimal surgical cyto reduction in ovarian cancer and so knowing the relevant Anatomy is important and um so we'll go over the ligaments um attaching to the spleen as well as the blood supply to the spleen so there are approximately five ligaments the splenophrenic ligament this one of renal the pancreatico splenic the splinocolic and the gastrosplenic ligaments they are labeled here one through four we have one two three four splenophrenic which you can't see with the diaphragm would be up here this Plano renal the pancreatico splenic the spleno colic and then over here we have the gastrosplenic each of these ligaments are transected during a splenectomy and then as far as our blood supply goes is a little bit easier you just have the splenic artery and the splenic vein as you can see here these come off the Celiac trunk the artery comes off the Celiac trunk and the Celiac trunk as you may remember is the splenic artery the left gastric and the common hepatic and then the splenic vein coming back into the portal vein the basic steps of a splenectomy are entering the Lesser Sac mobilizing the spleen and then ligating the vessels which sounds very easy however in practice is definitely scary for gynancx there is an anterior or posterior approach and the choice depends on the distribution of disease whatever approach would be easier based on disease and I will be going over the anterior approach in this short lecture so first entering the Lesser sack of the omentum you want to identify the gastrocolic ligament this lies between the stomach's greater curvature and the transverse colon the anterior relief of the omentum attaches to the greater curvature of the stomach via the gastrocolic ligament and the posterior Leaf attaches to the margin of the transverse colon and the Lesser Sac is kind of between these two leaves so identifying the ligament and then transecting this in order to open the Lesser sac the dissection then this is a another depiction of opening the Lesser sack but the momentum is no longer there um and you as you can see here this is the uh gastro colic ligament here the dissection continues along the transverse colon with mobilization of the entire splenic flexure of the colon to eventually reach the splenocholic ligament highlighted here and then you're also dissecting upward to the greater curvature of the stomach towards the gastrosplenic ligament that's here once mobilized you can grasp the spleen and elevate it immediately this will expose the splenophrenic ligament here and you can continue to dissect the spleen from the gastrospinic ligament as well as the spinal colic ligand so you can see the gastrospanic ligma in this picture as well as the spinal colic ligament here you'll continue dissecting that and then also the splenophrenic ligament with this being the diaphragm the gastrosplenic ligament is the most vascular and contains those short gastric arteries so we are very careful in ligating and dividing these and then finally the spleen is elevated to the incision you do some blunt to section in order to identify the splenic artery in the splenic vein the each one of these vessels are individually ligated and the artery is ligated first in order to prevent engorgement of the spleen you can use as depicted here or right angle placed underneath the artery or individual vein artery or vascular pedicle and you can use a 2o silk you will then place a second 2o silk and then on the proximal end you can either tie or clip this end and then divide the artery vein or other vascular pedicle and then if you're done with the artery you do the vein and that is the end of the swenectomy