Fig. 1

Skin incision and port placement of hand-assisted laparoscopic devascularization and splenectomy. An 8.0-cm upper midline incision was made to introduce a hand port. After the abdomen was insufflated to 10 mmHg with carbon dioxide, the first trocar (12 mm) was inserted on the left side of the umbilicus. A flexible-type laparoscope was placed into the abdomen. Two other 12-mm trocars were inserted under laparoscopic observation to the left of the first trocar and on the left flank of the anterior axillar line, respectively, and one 5-mm trocar was inserted into the left subcostal area