Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism

Figure 2 Surgical procedure of partial splenectomy during liver transplantation. A: Partial splenectomy for severe hypersplenism was performed after classic orthotopic liver transplantation; B: The main splenic artery was isolated and exposed; C: The hilar vessels from the lower pole of the spleen were selectively ligated; D: The main collateral circulation of the spleen was isolated and ligated; E: Ischemic demarcation line became observable; F: The spleen was resected along the ischemic line using a Cavitron ultrasonic surgical aspirator and bipolar coagulation forceps; G: The segmental hilar vessels were allowed to remain with the splenic remnant; H: The spleen specimen.