Pediatric laparoscopic splenectomy using a repurposed sterile diathermy pouch as a retrieval bag: preliminary experience

Abstract

INTRODUCTION: Laparoscopic splenectomy is increasingly performed in pediatric patients due to its well-established advantages over open surgery. However, specialized commercial retrieval bags used for specimen extraction add to procedural cost and may not be readily available in resource-limited settings. This study evaluated the feasibility and safety of a handmade retrieval pouch fashioned from a sterile diathermy pouch for pediatric laparoscopic splenectomy. METHODS: The study included 25 children aged 3 to 15 years who underwent elective laparoscopic splenectomy for benign hematologic disorders. A retrieval pouch was prepared from a sterile diathermy pouch supplied as part of the disposable sterile towel set. After spleen enclosure, the pouch opening was closed with a running suture and exteriorized through the umbilical incision for controlled in-bag fragmentation and extraction. The primary outcome was successful specimen retrieval without bag failure or conversion. RESULTS: The technique was successfully utilized in all 25 cases with no intraoperative complications. Spleen size ranged from 12 to 22 cm. Mean retrieval time was 36 min, decreasing from 120 min in the first case to 33 min in subsequent cases. Larger spleens (> 16 cm) required longer extraction times (47.0 ± 10.6 vs. 25.0 ± 2.7 min, p < 0.001). Patients experienced rapid recovery (mean hospital stay 1.7 ± 0.8 days) and excellent outcomes, with 92% reporting maximum satisfaction with cosmetic results and no postoperative complications at 3-month follow-up. CONCLUSION: In this preliminary series, use of a retrieval bag fashioned from a repurposed sterile diathermy pouch was feasible and safe for pediatric laparoscopic splenectomy across a broad range of splenic sizes, without additional incisions or retrieval-related complications.