Abstract
Background
Laparoscopic splenectomy (LS) is becoming the gold standard for the treatment of hematological disease in children. Intraoperative bleeding is the main complication and main cause of conversion during LS. We present the use of the LigaSure Vessel Sealing System for achieving a safe vascular control, compared with previous techniques.
Methods
LigaSure is an energy-based device which works by applying a precise amount of bipolar energy and pressure to the tissue, thus achieving a permanent seal. We have performed a total of 15 LS in children during 6 years, on 6 males and 9 females with a median age of 11 years (range 5–17). Seven children had hereditary spherocytosis, 4 thrombocytopenic idiopatic purpura (ITP), 3 β talassemia, and 1 hemolytic anemia. Patients were divided into two groups according to the method of dissection: group 1 ultrasonic coagulation+endostapler (8 pts); group 2 LigaSure (7 pts). We employed a 4 trocars technique with right semilateral position.
Results
The groups were well-matched for age, gender, weight, indication and spleen size. Fourteen LS were completed with one conversion (7%) because of hilar bleeding due to accidental injury with endostapler. Median operative time of the series was 140 min (range 90–205), significantly shorter in the group 2 (130 min versus 155 min, P<0.05), as well as median blood loss (group 1, 180 ml versus group 2, 70 ml, P<0.05). There was no mortality, with one postoperative complication (7%) (pulmonary atelectasis). The median postoperative hospital stay was 4 days (range 2–5) without differences between groups.
Conclusions
Each method of dissection seems to be safe and effective. Otherwise LigaSure results in a reduction of operating time and blood loss.
Similar content being viewed by others
References
Waldhausen JHT, Tapper D (1997) Is pediatric laparoscopic splenectomy safe and cost-effective? Arch Surg132:822–824
Hicks BA, Thompson WR, Rogers ZR, Guzzetta PC (1996) Laparoscopic splenectomy in childhood hematological disorders. J Laparoendosc Surg 6:31–34
Fitzgerald PG, Langer JC, Cameron BH, Park AE, Marcaccio MJ, Walton JM, Skinner MA (1996) Pediatric laparoscopic splenectomy using lateral approach. Surg Endosc 10:859–861
Beanes S, Emil S, Kosi M, Applebaum H, Atkinson J. A comparison of laparoscopic versus open splenectomy in children. Am Surg 1995;61:908–910
Rescorla FJ, Breitfeld PP, West KW, Williams D, Engum SA, Grosfeld JL (1998) A case controlled comparison of open and laparoscopic splenectomy in children. Surgery 124:670–675
Janu PG, Rogers DA, Lobe TE (1996) A comparison of laparoscopic and traditional open splenectomy in childhood. J Pediatr Surg 1:109–114
Liu DC, Meyers MO, Hill CB, Loe WA (2000) Laparoscopic splenectomy in children with haematological disorders: preliminary experience at the Children’s Hospital of New Orleans. Am Surg 66:1168–1170
Esposito C, Corcione F, Ascione G, Garipoli V, Di Pietto F, De Pasquale M (1998) Splenectomy in childhood: The laparoscopic approach. Surg Endosc 12:1445–1448
Park A, Heniford BT, Hebra A, Fitzgerald P (2000) Pediatric laparoscopic splenectomy. Surg Endosc 14:527–531
Meijer DW, Gossot D, Jakimowicz JJ, De Wit LT, Bannemberg JJ, Gouma DJ (1999) Splenectomy revised: manually assisted splenectomy with the dexterity device: a feasibility study in 22 patients. J Laparoendosc Adv Surg Tech A 9:507–510
Poulin EC, Mamazza J, Schlachta CM (1998) Splenic artery embolization before laparoscopic splenectomy. An update. Surg Endosc 12:870–875
Kennedy JS, Shanahan PL, Taylor KD, Chandler JG (1998) High-burst strenght, feed-back controlled bipolar vessel sealing. Surg Endosc 12:876–878
Shamiyeh A, Schrenk P, Tulipan L, Vattay P, Bogner S, Wayand W (2002) A new bipolar feed-back controlled sealing system for closure of the cystic duct and artery. Surg Endosc 16:812–813
Sandoval C, Stringel G, Ozkaynak MF, Tugal O, Jayabose S (2000) Laparoscopic splenectomy in pediatric patients with hematologic disease. JSLS 4:117–120
Minkes RK, Lagzdins M, Langer JC (2000) Laparoscopic versus open splenectomy in children. J Pediatr Surg 35:699–701
Rescorla FJ, Engum SA, West KW (2002) Laparoscopic splenectomy has become the gold standard in children. Am Surg 68:297–301
Reddy VS, Phan HH, O’Neill JA, Neblett WW, Pietsch JB, Morgan WM, Cywes R (2001) Laparoscopic versus open splenectomy in the pediatric population: a contemporary single-center experience. Am Surg 67:859–863
Curran TJ, Foley MI, Swanstrom LL, Campbell TJ (1998) Laparoscopy improves outcomes for pediatric splenectomy. J Pediatr Surg 33:1498–1500
Strasberg SM, Drebin JA, Linehan D (2002) Use of a bipolar vessel sealing device for parenchymal transection during liver surgery. J Gastrointest Surg 6:569–574
Matthews BD, Pratt BL, Backus CL, Kercher KW, Mostafa G, Lentzner A, Lipford EH, Sing RF, Heniford BT (2001) Effectiveness of the ultrasonic coagulation shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis. Am Surg 67:901–906
Shigemura N, Akashi A, Nakagiri T (2002) New operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the LigaSure system. Eur J Cardiothorac Surg 22:646–648
Crawford ED, Kennedy JS, Sieve V (1999) Use of the LigaSure Vessel Sealing System in urologic cancer surgery. Grand Round Urol 1:10–17
Kennedy JS, Buysse SP, Lowes KR, Ryan TP (1999) Recent innovation in bipolar electrosurgery. Minimally Invasive Ther Allied Technol 8:95–99
Heniford BT, Matthews BD, Sing RF, Backus C, Pratt B, Greene FL (2001) Initial results with an electrothermal bipolar vessel sealer. Surg Endosc 15:799–801
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Romano, F., Caprotti, R., Franciosi, C. et al. The use of LigaSure during pediatric laparoscopic splenectomy: a preliminary report. Ped Surgery Int 19, 721–724 (2003). https://doi.org/10.1007/s00383-003-1037-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-003-1037-y