ABSTRACT

Objective:

Laparoscopic splenectomy (LS) became the first procedure of choice in the years of 90 in many institutions. Initially staplers were used to ligate hilar vessels. Recently harmonic scalpels are being used for dissection and ligations. Here we present our experience with vessel sealing device (Ligasure) during whole procedures of dissection in laparoscopic splenectomy.

Material and Methods:

Between June 2006 and September 2007, 25 children (8 girls and 17 boys) aged 1-16 years were hospitalized for laparoscopic splenectomy.

Results:

Indications for splenectomy were idiopatic thrombocytopenic purpura (n=10), hereditary spherocytosis (n=6), thalassemia (n=8) and autoimmun hemolitic anemia (n=1). Ultrasonograpically measured spleen length varied between 80 and 192 mm. Three trocars were used for 16 patiens, but a fourth trocar was needed in nine patients. Vessel sealing device was used for sealing and cutting of all vascular structures. Staplers or suture ligation were not necessary. Spleen was put into the retrieval bag and removed from the umbilical trocar site after fragmentation with an ovary forceps. In four patients conversion to open surgery was made because of problems in dissection in two patients, bleeding in one and hypercarbia in another patient although the diseection was completed. Splenic sizes were larger than the sizes given by ultrasonograpy. Operative time was between 45 and 240 minutes (mean 154.6 minutes). No complication developed except one patient who suffered pleural effusion. Patients were discharged in mean 4.04 (2-12) days.

Conclusion:

In LS as a gold standart in elective splenecyomy, use of vessel sealing device (Ligasure) has a lot of advantages including higher comfort provided to the surgeon, reduction in bleeding and thus providing a good view, acceptable decreased length of operation time, being effective and safe method to be applied in children undergoing elective splenectomy.