Ultrasonic shear coagulation of main hilar vessels: A 4-year experience of 23 pediatric laparoscopic splenectomies without staples.
BACKGROUND
Ultrasonic shears (LCS) are used increasingly for laparoscopic splenectomy. So far however, all investigators use vascular staplers or clips for section of the main splenic artery and vein.


METHODS
After several trials the authors started to use the ultrasonic triple welding technique in open surgery to occlude major vessels of 5 to 8 mm by 10-mm LCS. In June 1997 the authors introduced triple welding into laparoscopic splenectomy to mobilize the complete spleen by LCS.


RESULTS
There was no hemorrhage in 23 laparoscopic splenectomies performed exclusively by LCS and no complications except 1 port site hernia.


CONCLUSIONS
Laparoscopic splenectomy entirely by reusable LCS without clips and stapler is a safe, simple, and inexpensive technique. Moreover, the policy of "leaving nothing back" is an attractive strategy in endoscopic pediatric surgery.
Schaarschmidt
Klaus
K
Helios Center of Pediatric Surgery, Berlin-Buch, Germany.
Kolberg-Schwerdt
Andreas
A
Lempe
Michael
M
Saxena
Amulya
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D013156:Splenectomy / Q000379:methods*; D013157:Splenic Artery / Q000601:surgery; D013162:Splenic Vein / Q000601:surgery; D013525:Surgical Instruments; D013537:Sutures; D014464:Ultrasonic Therapy / Q000379:methods*