Laparoscopic Staple-less Splenectomy: feasibility and benefits

Abstract

Background: The surgical procedures of the spleen include open splenectomy (OS) laparoscopic splenectomy (LS). Several techniques for control of splenic vessels during LS have been developed, such as Clips, sutures, bipolar vessel sealing devices as Liga-Sure and ultrasonic devices as Harmonic have. The vessel sealing devices shows some advantages if compared with other methods such as staplers and clips as shorter hospital stay, safer, feasible and excellent cosmetic results. And vessel sealing devices (Liga-Sure) LS is cheap alternative to the use of endo-staplers which is expensive. Objectives:The study is to evaluate feasibility, merits and demerits of staple-less laparoscopic splenectomy in cases of non-traumatic disorders of spleen and assess operative time, need for blood transfusion, rate of conversion to open splenectomy or use stapler, period of hospital stay and associated complications. Patients and Methods: The study was conducted on 32 patients, underwent laparoscopic splenectomy using vessel sealing devices (Ligasure) for splenic pedicle control. Informed consent was obtained for all patients. Results: The study was conducted on 32 patients. 30 patients (93.80%) were females and 2 patients (6.3%) were males. 30 patient with immune thrombocytopenic purpura (ITP) and 2 patients with hereditary spherocytosis (HS). Two cases (6.3%) detected with accessory spleen (splenule) at the splenic hilum. Two cases (6.3%) were converted to open splenectomy. To control bleeding, we used stapler in two cases (6.3%). Cost of staple-less LS is less expensive than stapler laparoscopic splenectomy as the stapler LS is more than staple-less LS by about 12000 EGP (700$). Conclusion: In a report in early 1990s, the dissection of the hilum of the spleen was generally achieved by surgical clips or endo-gastrointestinal staplers. Subsequently, new surgical tools such as ultrasonic devices or bipolar electrosurgical devices such as LigaSure had been employed as supporting device that can seal blood vessels with supra-physiologic burst pressures equal to those obtained with surgical clips or ligatures. We, in this series, believe that it is, with a statistical significance, safe and effective, reduces blood loss, minimize operating time, fewer costs and is a valid. Moreover, it reduced conversion rates in selected patients. Last but not least, the use of the vessel sealing devices (Ligasure) resulted in no post-operative complications or need of blood transfusion.

Safe staple less laparoscopic splenectomy; use of Hem-o-Lok to control the splenic hilum

“…7 Despite the primary concerns of a prolonged operative time and intraoperative bleeding, LS has become superior to open splenectomy as it guarantees a shorter hospital stay, low complications and cosmetically better results. 8,9 Numerous methods, including clips, ligatures, ultrasonic shears as harmonic, ligasure and endovascular staplers, are employed to manage splenic vascularity in order to shorten the surgical time and decrease intraoperative complications. 10 The Hem-o-Lok clip was introduced in 1963 as a metallic clip which was initially used for the control of the renal pedicle during nephrectomy.…”