title: The use of LigaSure during pediatric laparoscopic splenectomy: a preliminary report.
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 beta 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.
authors.affiliation: Department of General and Pediatric Surgery (Chirurgia I), San Gerardo Hospital, II University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy. fabriziorom@hotmail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
authors.forename: Roberto
authors.initials: R
authors.lastname: Caprotti
authors.forename: Claudio
authors.initials: C
authors.lastname: Franciosi
authors.forename: Sergio
authors.initials: S
authors.lastname: De Fina
authors.forename: Giovanni
authors.initials: G
authors.lastname: Colombo
authors.forename: Paola
authors.initials: P
authors.lastname: Sartori
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D013156:Splenectomy / Q000379:methods*