Laparoscopic Splenectomy and LigaSure

Abstract

Laparoscopic splenectomy (LS) is a preferred choice, especially for hematologic diseases. We present the advantages of the use of LigaSure (energy-based equipment that works by applying a precise amount of bipolar energy and pressure to the tissue, achieving a permanent seal) for achieving a precise hemostasis, thus making the LS easier. We have performed LS using LigaSure on 10 patients (4 female, 6 male; mean age, 36 years [range, 16-58]) between December 2002 and August 2003. All patients had ITP. There were no conversion to open surgery. Mean dimensions of spleens were 99 x 49 mm (range, 85 x 36-118 x 60). Intraoperative blood loss was no more than 100 mL in any patients (range, 20-100; mean, 60). The average operative time was 93 minutes (range, 60-155). There were no complications in the postoperative period. The average postoperative stay was 4.3 days (range, 3-7). LS using LigaSure is a safe and time-sparing procedure with almost no complications in this small initial series.

Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Yüney et al [124] performed LS for 10 patients with ITP using LigaSure TM for hilar vessel sealing. The mean blood loss was 60 ml, and the average operating time was 93 min, without any conversions or complications in the postoperative period (LoE 4).…”

“…Use of the endovascular stapler is reported to shorten and facilitate hilar dissection compared with the former techniques of ligation or clipping (LoE 4) [121,123]. Recently, electrothermal bipolar vessel sealer (LigaSure TM ) or ultrasonic coagulating shears (Ultracision Harmonic Scalpel TM , Ethicon Endosurgical, Cincinnati, OH) have been used for dissection of smaller polar vessels and the small gastric vessels (LoE 4) [124], vesselcontaining tissue (LoE 4) [39,125,126], or even the greater hilar vessels (LoE4) [127]. Romano et al [128,129] reported the safe use of LigaSure TM for hilar vessels with a diameter up to 7 mm in patients with normal-sized to slightly enlarged spleens as well as lower blood loss, shorter operative time, and even lower costs than with other techniques (LoE 2b).…”

Optimizing the technique of laparoscopic splenectomy in children

“…As the increased cost of laparoscopic splenectomy is mostly driven by the price of tools, especially disposable ones, they suggest reusing them. Yünney and Hamamci confirm in practice, with results of bacteriological studies, that preparation tools, trocars and the LigaSure device can be successfully re-sterilized and re-used [16,39]. The cost of a single application of LigaSure coagulation is 1980 zlotys.…”

“…The cost of a single application of LigaSure coagulation is 1980 zlotys. Considering 4 or 5-time usage of LigaSure coagulation, according to Yüney's publication, the cost for a single procedure would be 396 zlotys [39]. Unfortunately, according to American and EU standards such a solution cannot be applied.…”

“…Cost analysis should be followed by an idea to decrease them. Turkish authors working in economic conditions and instruments/hospitalization cost ratios similar to the Polish conditions put forth such a proposition [16,39]. As the increased cost of laparoscopic splenectomy is mostly driven by the price of tools, especially disposable ones, they suggest reusing them.…”