[The value of spleen sub-pedicle two steps severance with LigaSure in laparoscopic splenectomy].
OBJECTIVE
To evaluate the safety and utility of the methods of spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy.


METHODS
The methods and the curative effect of 32 patients with laparoscopic splenectomy performed by the way as mentioned above were summarized and analyzed. 4 males, 28 females, median 36 years (range 16 - 64 years). Mean dimensions of spleens were 17 cm (range 11 - 23 cm). Nineteen patients had idiopathic thrombocytopenia purpura (ITP), 6 hereditary spherocytosis (HS) (5 of them were the same family constellation), 3 hemolytic anemia (HA), 2 spleen injury with haematoma infection, 1 Evan syndrome, 1 leukemia. Peri-splenic ligaments were resected by LigaSure combined with ultrasound scalpel, splenic pedicle was resected by spleen sub-pedicle two steps severance with LigaSure when splenic pedicle were sufficiently free. Splenic pedicle was non-excisional occluded by LigaSure at pancreatic cauda, in the first step and was occluded and resected alongside of the spleen in the second step.


RESULTS
All of the 32 cases were completely succeed, the average operating time was 70 min (55 - 130 min), the estimated intraoperative blood loss was 200 ml (50 - 600 ml), no complications such as abdominal haemorrhage, visceral injury, pancreatic leakage and infection were observed. All the patients were healed well, the average hospital stay after an operation was 6 days. The average expense of each patients could save 8050 yuan because Endo-GIA was not used.


CONCLUSIONS
Spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy, which shorten the operating persistence time with less hemorrhage is a safe, effective and low-cost minimally invasive surgery in selective cases.
Wang
Guang-yi
GY
Department of General Surgery, First Hospital of Jilin University, Changchun 130021, China. wgymd@sina.com
Liu
Ya-hui
YH
Lü
Guo-yue
GY
Liu
Kai
K
Zhang
Wei
W
Li
Nan
N
Tan
Yu-quan
YQ
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery; D008026:Ligation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013157:Splenic Artery / Q000601:surgery; D013162:Splenic Vein / Q000601:surgery; D016896:Treatment Outcome