Laparoscopic splenectomy with radiofrequency. SLS annual meeting – 14th international congress and endoexpo, S.Diego (USA) 14-17 settembre 2005

O b j e c t i v e : Intraoperative bleeding is the main complication and cause of conversion during laparoscopic splenectomy (LS). We present the advantages of the use of the Ligasure Vessel Sealing System added to a lateral approach for achieving safe vascular control. Method: Ligasure applies a precise amount of bipolar en- ergy and pressure to the tissue, achieving a permanent seal. We have performed 55 LS by using a technique with 4 trocars, a right semi-lateral position, and dissection of the 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), diffuse peritoneal adhesions (1), and massive splenomegaly (1). The average splenic weight was 485 g, with an average diameter 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 who underwent 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 of the spleno-portal axis (1); hemoperitoneum due to a pan- creatic tail bleed, laparoscopically treated (1); and pleural effusion (1). The average postoperative hospital stay was 4.2 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 very low.