Stapleless laparoscopic splenectomy using harmonic scalpel by 2-step sealing.

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Gastrointestinal Surgery

Background:

• Laparoscopic splenectomy (LS) is a standard procedure, often using clip ligation for hemostasis.
• Alternative energy devices are being explored to improve hemostasis during LS.
• The LigaSure system has been reported as an alternative to clip ligation.

Observation:

• This report details the initial experience of using the Harmonic Scalpel laparoscopic coagulating shears (LCS) for LS.
• The procedure was performed on a patient diagnosed with idiopathic thrombocytopenic purpura (ITP).
• Vessels in the splenic pedicle, approximately 5 mm in diameter, were sealed using a two-step method with LCS, without Endo-GIA stapler use.

Findings:

• The laparoscopic splenectomy (LS) with Harmonic Scalpel laparoscopic coagulating shears (LCS) was completed successfully.
• Operative time was 93 minutes, with minimal blood loss of 40 mL.
• The patient experienced no intraoperative or postoperative complications and was discharged on postoperative day three.

Implications:

• The Harmonic Scalpel laparoscopic coagulating shears (LCS) demonstrate potential as a safe alternative energy device for hemostasis in laparoscopic splenectomy (LS).
• This preliminary experience suggests the feasibility of a two-step sealing technique with LCS for splenic pedicle vessels.
• Further clinical studies are warranted to validate the safety and efficacy of LCS in a broader patient population undergoing LS.