Machado Norman Oneil, Al Kindy Nayil, Chopra Pradeep J
Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.
JSLS. 2010 Oct-Dec;14(4):547-52. doi: 10.4293/108680810X12924466008286.
Laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases. Bleeding is the main complication and cause for conversion. We present our experience with the LigaSure and discuss its advantage as a vessel sealing system in achieving safe vascular control.
Over a 3-year period, we performed 12 consecutive LS using LigaSure at a single center. A literature review of all the patients who had undergone laparoscopic splenectomy with of the LigaSure to achieve vascular control at the hilum was carried out, assessing its advantages and outcome.
Twelve LS were performed. Eleven of these patients had ITP, and one patient had sickle cell disease. The mean blood loss was 70mL (range, 50 to 460), and operating time was 126 minutes (range, 110 to 240). Two postoperative complications occurred: portal vein thrombosis in one case and subphrenic collection in the other. The literature review revealed 8 studies with 231 cases in which the LigaSure was used to perform laparoscopic splenectomy. A significant reduction in operating time (average 102 minutes) and intraabdominal blood loss (66mL) was observed with the LigaSure compared with endostaplers.
The use of LigaSure and the semilateral position results in a gain of time and safety in addition to low intraoperative bleeding, need for transfusion, minimal complications and a low conversion rate.
腹腔镜脾切除术（LS）已成为大多数脾切除病例的标准术式。出血是主要并发症及中转开腹的原因。我们介绍使用LigaSure的经验，并讨论其作为血管封闭系统在实现安全血管控制方面的优势。
在3年期间，我们在单一中心连续进行了12例使用LigaSure的LS手术。对所有接受腹腔镜脾切除术并使用LigaSure控制脾门血管的患者进行文献回顾，评估其优势和结果。
共进行了12例LS手术。其中11例患者患有特发性血小板减少性紫癜（ITP），1例患者患有镰状细胞病。平均失血量为70mL（范围50至460mL），手术时间为126分钟（范围110至240分钟）。发生了2例术后并发症：1例门静脉血栓形成，另1例膈下积液。文献回顾显示有8项研究共231例病例使用LigaSure进行腹腔镜脾切除术。与内镜吻合器相比，使用LigaSure观察到手术时间（平均102分钟）和腹腔内失血量（66mL）显著减少。
使用LigaSure并采用半侧卧位，除了术中出血少、无需输血、并发症极少和中转率低外，还能节省时间并提高安全性。
