Stapleless laparoscopic splenectomy in haematological disorders using LigaSure

Abstract

Both technical and technological advances over the past few years have made laparoscopic splenectomy (LS) more feasible and acceptable. Intraoperative bleeding is the main complication and cause of conversion during LS. Different hemostatic techniques are used for vascular control. In this study, we evaluate LigaSure vessel sealing system as the sole instrument in addition to the lateral approach for achieving a safe vascular control.Eleven patients with hematological disorders of the spleen were enrolled in this 2 year study for LS at Ain Shams University Hospitals. Eight patients had idiopathic thrombocytopenic purpura (ITP), two patients with hereditary spherocytosis and one patient with Evan's syndrome.In all patients the LigaSure vessel sealing system with lateral approach was used to achieve safe vascular control. The patients were 6 females and 5 males, their age ranging between 17-23 years (Median= 20 yrs). The intraoperative blood loss, need for blood transfusion, operative time, post-operative complications and hospital stay as well as the cost were evaluated.Nine cases were successfully performed laparoscopically with two conversions due to hilar bleeding. In all but two patients (converted patients) the intra-operative blood loss was less than 100ml (range 50-100ml) with no need for blood transfusion.The operative time range was 70-100 minutes (median 85 minutes). There were no mortalities in our series. The average hospital stay was 4 days (range 3-5 days), and apart from minor wound infection, no post operative complications were recorded.Stapleless LS using LigaSure vessel sealing system with the lateral approach is a safe procedure to carry out laparoscopic splenectomy.