Laparoscopic splenectomy with radiofrequency

O b j e c t i v e : Intraoperative bleeding is the maincomplication and cause of conversion during laparoscopicsplenectomy (LS). We present the advantages of the useof the Ligasure Vessel Sealing System added to a lateralapproach for achieving safe vascular control.Method: Ligasure applies a precise amount of bipolar en-ergy and pressure to the tissue, achieving a permanentseal. We have performed 55 LS by using a technique with4 trocars, a right semi-lateral position, and dissection ofthe spleen and vessels sealing with 10mm LigaSure Atlas.The indications were thrombocytopenic idiopathic pur-pura (20), spherocytosis (12), b thalassemia (6), lym-phoma (15), hemolytic anemia (1), and splenic cyst (1).Results: LS was completed in 51 patients with 4 (7.2 %)conversions because of hilar bleeding due to accidental injury (1), difficult splenic hilar dissection (1), diffuseperitoneal adhesions (1), and massive splenomegaly (1).The average splenic weight was 485 g, with an averagediameter of 15.2 cm. In all but 4 patients, the intraopera-tive blood loss was less than 100 mL. The average opera-tive time was 121.6 minutes, including 15 patients whounderwent the following combined operations: cholecys-tectomy (9), hepatic biopsy and hilar lymphadenectomy(3), adhesion dissection (3). No mortality and 3 (5.4%)postoperative complications occurred, ie, thrombosis ofthe spleno-portal axis (1); hemoperitoneum due to a pan-creatic tail bleed, laparoscopically treated (1); and pleuraleffusion (1). The average postoperative hospital stay was4.2 days.Conclusion: The use of LigaSure associated with the se-milateral position results in a gain of time and safety.Furthermore, the average intraoperative bleeding is verylow.