Both splenectomy and hepatectomy were initially believed to be contraindications for laparoscopic surgery, but improvements in techniques mean that these conditions can now be managed successfully using this approach. 1,2 The recovery of a large, solid organ is a major obstacle, and possibly the most difficult aspect of laparoscopic surgery. Various methods and devices 3 have been proposed for this purpose, including the Lahey bag, a pouch suspended from the abdominal wall (in both cases, with morcellation of the viscera), assisted laparoscopy, and expansion of the incision, but none has been shown to be fully effective. If morcellation is performed, this is very time consuming and this technique cannot be used if the pathologist requires the entire specimen. Furthermore, it increases the risk of material falling into the abdominal cavity 4 (and thus its dissemination, if a tumor is present, or possible intraperitoneal implant if a splenectomy has been performed). In cases of assisted laparoscopy or expansion of the incision, larger incisions are made, and the advantages of laparoscopic surgery are then lost.We propose extraction of the specimen by means of a 1500 to 3000 W suction system connected to a transparent container, which in turn is connected to the extraction bag (once the organ has been introduced into it). Vaseline is extended over the inner surface of the bag and around the orifice in the abdominal wall, and a traction maneuver is performed simultaneously with the suction.This system enables the specimen to be extracted without fragmentation, through a rigid opening, measuring 5 cm in vitro, or 3.5 to 4.0 cm in vivo. In this maneuver, which was performed experimentally on a methacrylate board with a 5 cm orifice (Figure 1), we were able to extract a specimen that was 19 cm in length and weighed 750 mg in a total time of 34 seconds, without fragmenting it, thus avoiding the risk of dissemination.If the preferred option is to fragment the specimen and to extract it through a smaller incision, all that is necessary is to increase the suction power; the specimen will then disintegrate and be retained in the transparent container, which is fitted with a metal mesh to keep the specimen from the suction mechanism. It is important to ensure that the container is of a diameter similar to that of the suction system, to avoid loss of suction power.In summary, this system would be suitable for all laparoscopic procedures requiring the removal of solid viscera, such as splenectomy, partial hepatectomy, hysterectomy, or nephrectomy. We believe its use would enable better results to be achieved, with smaller incisions, reduced surgical time and less risk of dissemination, while allowing the surgical specimen to be extracted intact. Figure 1. Specimen (19 cm in length and weighing 750 mg) extracted without fragmentation, through a rigid opening on a methacrylate board with a 5 cm orifice.

Background: The number of laparoscopic procedures done each year continues to rise substantially. Clinically significant hemorrhage from secondary port sites at laparoscopy is an uncommon but serious complication and can become unrecognized intraoperatively. Abdominal wall hemorrhage and bruising may complicate laparoscopic operative procedures. Methods: We propose an easy technical gesture to stop the bleeding at the port site in laparoscopic surgery. A simple technique is described to treat this complication. Conclusions: Our proposal is a simple gesture, easy to reproduce and, with no surgical time waste which we can obtain very good results in major bleeding difficult to control with traditional methods by that.