Safety and Efficacy of Using Staplers and Vessel Sealing Devices for Laparoscopic Splenectomy: A Randomized Controlled Trial

Abstract

Background. Laparoscopic splenectomy (LS) is considered the operation of choice on elective basis for managing patients with certain hematological disorders. Hemostatic control of the splenic pedicle is one of the crucial steps in LS. This study compares the safety and efficacy of using endoscopic staplers and vessel sealing devices to control the splenic pedicle in patients with nonsevere splenomegaly. Methods. Fifty-one consecutive patients with different blood disorders including idiopathic thrombocytopenic purpura (ITP), hypersplenism, and lymphoma were randomized for elective LS. Traditional steps of LS, via lateral approach, were followed, and pedicle control was done with either endovascular gastrointestinal anastomosis stapler (n = 26) or vessel sealing device (Ligasure) (n = 25). Results. No difference was noted with different splenic spans when using either methods of pedicle control ( P = .145). The volume of blood loss was higher in the Ligasure group compared to the staplers group (182 mL vs 131 mL, respectively), but was not statistically significant ( P = .249). Conversion to open was notably higher in the Ligasure group ( P = .034), but the intraoperative complications were comparable in both groups ( P = .357). Conclusion. The use of vessel sealing devices for splenic pedicle control has comparable surgical outcomes compared with the use of endoscopic staplers for LS, but with higher rate of conversion to open surgery.

A laparoscopic approach to address massive splenomegaly, symptomatic cholelithiasis, and a planned postoperative pregnancy: A case report

“… 13 , 14 Newer surgical energy devices, including the Valley Lab LigaSure vessel‐sealing system and Ethicon Harmonic Scalpel, reduce blood loss and operative time. 15 , 16 Three investigators have reported a reduced number of bleeding complications when preoperative splenic artery embolization was performed. 17 , 18 , 19 Elective splenectomy allows vaccination to be completed at least 2 weeks preoperatively; if vaccination has not been performed preoperatively, an 8‐week interval is recommended prior to postoperative vaccination of the patient.…”

“…Some surgeons advocate for single‐port laparoscopy as it provides a larger incision for spleen extraction 13,14 . Newer surgical energy devices, including the Valley Lab LigaSure vessel‐sealing system and Ethicon Harmonic Scalpel, reduce blood loss and operative time 15,16 . Three investigators have reported a reduced number of bleeding complications when preoperative splenic artery embolization was performed 17–19 .…”

LigaSure technique for splenectomy: A systematic review and meta-analysis

“…All eligible studies were screened for their methods, characteristics, and risk of bias strictly. [15–20]…”

“…All eligible studies were screened for their methods, characteristics, and risk of bias strictly. [15][16][17][18][19][20] In this meta-analysis, 2 different kinds of groups were generated from the included papers that met the criteria of the LigaSure group and the convention group. The convention method referred to traditional methods of excision and hemostasis, including ultrasonic coagulation + EndoGIA, clip, and silk suture ligation.…”

“…After checking the abstracts according to our predefined inclusion and exclusion criteria, 620 references remained for further evaluation. Six studies that documented adequate comparisons between LigaSure and conventional techniques regarding splenectomy were determined for this meta-analysis [15][16][17][18][19][20] (Fig. 1).…”