Different methods of dissection during laparoscopic splenectomy

Background: Laparoscopic splenectomy (LS) is considered the gold standard for the treatment of hematologic disease of the spleen. Intraoperative bleeding is the main complication and main cause of conversion during laparoscopic splenectomy. Splenic and hilar dissection are sometimes difficult and different technologies have been applied to achieve it. We here present our experience with 110 LS using two different instruments for spleen dissection and hilar vascular control .Methods: We have performed a total of 110 LS in nine years period in two affiliated University Hospitals. There were 50 males and 60 females (median age 34 yrs) and we employed a 4 trocars technique with right semilateral position. Indications were as follows: 41 thrombocytopenic idiopatic purpura (ITP), 30 hereditary spherocytosis, 9  talassemia, 25 Limphoma, 2 leukemia and 3 splenic cysts. Associated procedure were present in 32 cases (28 cholecystectomy and four liver/lymphnodal biopsies). Patients were divided in two group according with method of dissection and hilar section (group 1 Endostapler + electrocoagulation 40 pts; group 2 Ligasure vessel sealing system 70 pts). Results: Groups were well matched according to age, indications, spleen sizes, procedures associated. Conversion rates (10 cases, 9%, five in each group), postoperative hospital stay (median 4 days in each group), intra and postoperative complications were similar in the 2 groups (with no statistically difference) without mortality in each group, while intraoperative blood loss (less of 100 ml in 55 patient of group 2, 78%, and in 21 of group 1, 52%), transfusion rates (8 pts in group 1 versus 4 in group 2) and operative mean time (150 min in group 1 versus 125 min in group 2) were less in the Ligasure vessel sealing device group(with a statistical significance). Conclusions: The approach to spleen dissection and hilum section was safe and efficacy in each case otherwise the use of LigasureTM results in a gain of time. Furthermore the average intraoperative bleeding and average transfusion rates of this series is lower in group 2.