Surgical Endoscopy

, Volume 32, Issue 5, pp 2550–2558 | Cite as

A blunt dissection technique using the LigaSure vessel-sealing device improves perioperative outcomes and postoperative splenic-vessel patency after laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy

  • Sungho Kim
  • Yoo-Seok YoonEmail author
  • Ho-Seong Han
  • Jai Young Cho
  • YoungRok Choi
  • In Gun Hyun
  • Kil Hwan Kim
Dynamic Manuscript



We have recently performed a blunt dissection technique using LigaSure technology for laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy to reduce the risk of bleeding during the dissection of the splenic vessels. The aim of this study was to compare the utility of the blunt dissection technique and a conventional dissection technique during laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy.


Fifty-five patients who underwent laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy performed by a single surgeon between March 2003 and December 2015 were enrolled in this retrospective single-center study. The patients were divided into the LigaSure group (n = 23) and non-LigaSure group (n = 26). Perioperative clinical outcomes and the postoperative patency of the preserved splenic vessels in the two groups were compared.


The patient and tumor characteristics did not differ significantly between the two groups. The incidence of postoperative complications was similar in the two groups. However, the mean operative time (145 vs. 231.1 min, P = 0.001), intraoperative blood loss (95.6 vs. 360 ml, P = 0.001), and postoperative hospital stay (6.4 vs. 9.8 days, P = 0.001) were significantly lower in the LigaSure group than in the non-LigaSure group, respectively. The splenic artery patency rate was similar in both groups, but the splenic vein patency was significantly better in the LigaSure group than in the non-LigaSure group (total occlusion rate: 4.5 vs. 30.8%, respectively, P = 0.017).


The results of this study suggest that the blunt dissection technique using a LigaSure reduces the operating time and intraoperative blood loss during laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy and increases the patency of the preserved splenic vessels.


Laparoscopy Splenic-vessel preservation Distal pancreatectomy LigaSure 


Compliance with ethical standards


Authors Sungho Kim, Yoo-Seok Yoon, Ho-Seong Han, Jai Young Cho, YoungRok Choi, In Gun Hyun, and Kil Hwan Kim have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 296099 KB)


  1. 1.
    Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kössler-Ebs J, Müller-Stich BP, Büchler MW, Hackert T, Diener MK (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 157:45–55CrossRefPubMedGoogle Scholar
  2. 2.
    Teh SH, Tseng D, Sheppard BC (2007) Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J Gastrointest Surg 11:1120–1125CrossRefPubMedGoogle Scholar
  3. 3.
    Briggs CD, Mann CD, Irving GRB, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137CrossRefPubMedGoogle Scholar
  4. 4.
    Kwon W, Jang J-Y, Kim JH, Chang YR, Jung W, Kang MJ, Kim S-W (2016) An analysis of complications, quality of life, and nutritional index after laparoscopic distal pancreatectomy with regard to spleen preservation. J Laparoendosc Adv Surg Tech A 26:335–342CrossRefPubMedGoogle Scholar
  5. 5.
    Shi N, Liu S-L, Li Y-T, You L, Dai M-H, Zhao Y-P (2016) Splenic preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol 23:365–374CrossRefPubMedGoogle Scholar
  6. 6.
    Waghorn DJ (2001) Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol 54:214–218CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Han H-S, Min SK, Lee HK, Kim S-W, Park Y-H (2005) Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign pancreas neoplasm. Surg Endosc 19:1367–1369CrossRefPubMedGoogle Scholar
  9. 9.
    Yu X, Li H, Jin C, Fu D, Di Y, Hao S, Li J (2015) Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg 400:183–191CrossRefPubMedGoogle Scholar
  10. 10.
    Yoon Y-S, Lee KH, Han H-S, Cho JY, Jang J-Y, Kim S-W, Lee WJ, Kang CM, Park S-J, Han S-S, Ahn YJ, Yu HC, Choi IS (2015) Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy: a retrospective multicenter study. Surg Endosc 29:583–588CrossRefPubMedGoogle Scholar
  11. 11.
    Yoon Y-S, Lee KH, Han H-S, Cho JY, Ahn KS (2009) Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy. Br J Surg 96:633–640CrossRefPubMedGoogle Scholar
  12. 12.
    Suzuki O, Tanaka E, Hirano S, Suzuoki M, Hashida H, Ichimura T, Sagawa N, Shichinohe T, Kondo S (2009) Efficacy of the electrothermal bipolar vessel sealer in laparoscopic spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. J Gastrointest Surg 13:155–158CrossRefPubMedGoogle Scholar
  13. 13.
    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernández-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 161:584–591CrossRefPubMedGoogle Scholar
  14. 14.
    Takiguchi N, Nagata M, Soda H, Nomura Y, Takayama W, Yasutomi J, Tohyama Y, Ryu M (2010) Multicenter randomized comparison of LigaSure versus conventional surgery for gastrointestinal carcinoma. Surg Today 40:1050–1054CrossRefPubMedGoogle Scholar
  15. 15.
    Fujita J, Takiguchi S, Nishikawa K, Kimura Y, Imamura H, Tamura S, Ebisui C, Kishi K, Fujitani K, Kurokawa Y, Mori M, Doki Y (2014) Randomized controlled trial of the LigaSure vessel sealing system versus conventional open gastrectomy for gastric cancer. Surg Today 44:1723–1729CrossRefPubMedGoogle Scholar
  16. 16.
    Patrlj L, Tuorto S, Fong Y (2010) Combined blunt-clamp dissection and LigaSure ligation for hepatic parenchyma dissection: postcoagulation technique. J Am Coll Surg 210:39–44CrossRefPubMedGoogle Scholar
  17. 17.
    Yao HS, Wang WJ, Wang Q, Gao WC, Xiang HG, Hu ZQ, Gao JD, Chen XY, Wang WM (2011) Randomized clinical trial of vessel sealing system (LigaSure) in esophagogastric devascularization and splenectomy in patients with portal hypertension. Am J Surg 202:82–90CrossRefPubMedGoogle Scholar
  18. 18.
    Pointer DT, Slakey LM, Slakey DP (2013) Safety and effectiveness of vessel sealing for dissection during pancreaticoduodenectomy. Am Surg 79:290–295PubMedGoogle Scholar
  19. 19.
    Eng OS, Goswami J, Moore D, Chen C, Brumbaugh J, Gannon CJ, August DA, Carpizo DR (2013) Safety and efficacy of LigaSure usage in pancreaticoduodenectomy. HPB 15:747–752CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Adam J-P, Jacquin A, Laurent C, Collet D, Masson B, Fernández-Cruz L, Sa Cunha A (2013) Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg 148:246–252CrossRefGoogle Scholar
  21. 21.
    Zhou ZQ, Kim SC, Song KB, Park K-M, Lee JH, Lee Y-J (2014) Laparoscopic spleen-preserving distal pancreatectomy: comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation. World J Surg 38:2973–2979CrossRefPubMedGoogle Scholar
  22. 22.
    Sánchez-Cabús S, Adam J-P, Pittau G, Gelli M, Cunha AS (2016) Laparoscopic left pancreatectomy: early results after 115 consecutive patients. Surg Endosc 30:4480–4488CrossRefPubMedGoogle Scholar
  23. 23.
    Dai M-H, Shi N, Xing C, Liao Q, Zhang T-P, Chen G, Wu W-M, Guo J-C, Liu Z-W, Zhao Y-P (2017) Splenic preservation in laparoscopic distal pancreatectomy. Br J Surg 104:452–462CrossRefPubMedGoogle Scholar
  24. 24.
    Sutton PA, Awad S, Perkins AC, Lobo DN (2010) Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure. Br J Surg 97:428–433CrossRefPubMedGoogle Scholar
  25. 25.
    Diamantis T, Gialikaris S, Kontos M, Gakiopoulou C, Felekouras E, Papalois A, Agrogiannis G, Patsouris E, Bastounis E (2008) Comparison of safety and efficacy of ultrasonic and bipolar thermal energy: an experimental study. Surg Laparosc Endosc Percutan Technol 18:384–390CrossRefGoogle Scholar
  26. 26.
    Braga M, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di Carlo V (2012) Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updates Surg 64:179–183CrossRefPubMedGoogle Scholar
  27. 27.
    de Rooij T, Cipriani F, Rawashdeh M, van Dieren S, Barbaro S, Abuawwad M, van Hilst J, Fontana M, Besselink MG, Abu Hilal M (2017) Single-surgeon learning curve in 111 laparoscopic distal pancreatectomies: does operative time tell the whole story? J Am Coll Surg 224:826–832.e1CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnam-siSouth Korea

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