Background
Laparoscopic treatment of splenic diseases has been restricted mainly to conditions for which total splenectomy is indicated. Laparoscopic spleen-preserving interventions for lesions located centrally in the spleen are extremely rare. This study aims to demonstrate and discuss our approach in such a patient.

Materials and Methods
A 35-year-old gentleman presented with left upper quadrant pain. Imaging studies revealed a thick wall, centrally located, perihilar 12 cm splenic cyst. The patient refused having catheter based diagnostic procedure and treatment by interventional radiology and underwent laparoscopic surgery.

Result
The patient was placed in the right lateral decubitus position. Three ports – one 10 mm and two 5 mm – were inserted in the left upper quadrant. Omental adhesions on the spleen are divided. Anteromedial tributaries of the splenic artery and vein were sealed and divided to expose as broad cystic outer surface as possible at the hilum. The cyst was entered next followed by suctioning of the cyst fluid. A 6x8 cm portion of the cyst wall was excised and all the inner surface of the remaining cyst de-epithelized using argon laser coagulation. The patient discharged home next day and the drain placed into the cyst cavity was removed POD 4. After 3 months, he is still being followed up without recurrence.

Conclusion
Our experience suggests that laparoscopic treatment of centrally located splenic cysts is safe and feasible. Meticulous surgical technique is key to performing this procedure safely using three- port approach.