Stapleless, clipless, and ligatureless laparoscopic splenectomy: possibilities and hazards

Abstract

Background: Elective open splenectomy is now fading in favor of the laparoscopic approach in different indications to remove the spleen. Reports are being published using either the LigaSure or the Harmonic Scalpel vessel sealing systems beside the classic hemoclips and Endo GIA staplers when dealing with the hilar vascular pedicle. Methods: 35 laparoscopic splenectomies were carried out for different indications since February 2013 till September 2016. Results: Splenic weights ranged from 140 to 1625 grams. Patient presentations were thalassemia major (n=16), hypersplenism (n=9), immune thrombocytopenic purpura (n= 6), hereditary sphirocytosis (n=2), lymphoma (n=1), benign splenic neoplasms (n=1). The Maryland LigaSure was the sole vessel sealing system used for Individual dissection and division of hilar, polar and marginal splenic vessels and for freeing the spleen of its ligamentous attachments. No other sealing system, clips, or staplers were used. Operative time ranged from 47 to 165 minutes. Only one case had to be converted due to bleeding. Sparing the converted case, blood loss ranged from 0 to 150 ml. Complications included one conversion due to hilar bleeding and one subphrenic collection. Conclusion: The sole utilization of the Maryland LigaSure system is safe, time sparing and cost effective in elective Splenectomy for different indications.