|
1
|
Kwon O, Paik KY. Laparoscopic adrenalectomy performed with the Endo GIA™ Stapler as an easy and safe approach. Minerva Surg 2025; 80:15-22. [PMID: 39356217 DOI: 10.23736/s2724-5691.24.10060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2024]
Abstract
BACKGROUND The purpose of this study was to determine whether the application of the Endo GIA™ Stapler (Medtronic, Dublin, Ireland) could be helpful in the dissection of adrenal tumors in complicated cases. METHODS We retrospectively reviewed the records of patients who underwent laparoscopic adrenalectomy between 2012 and 2022 at the College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea (Seoul, Republic of Korea). We adopted the Endo GIA™ Stapler (Medtronic) to seal vessels around adrenal gland and separate adrenal gland completely when it was difficult to perform meticulous dissection and isolation with laparoscopic instruments. Thirteen patients who underwent laparoscopic adrenalectomy with Endo GIA™ staplers were reviewed and compared with 45 other patients who underwent laparoscopic adrenalectomy without Endo GIA™ staplers. RESULTS There were no statistical differences between the two groups in demographic, tumor-related, and diagnostic variables. Surgical outcomes such as margin involvement, bleeding, operation duration, rate of conversion to open surgery, blood transfusion, complications, and recurrence were not different between the two groups. CONCLUSIONS In our experience, applying of the Endo GIA™ Stapler (Medtronic) in laparoscopic adrenalectomy is a feasible and acceptable approach.
Collapse
Affiliation(s)
- Ohjoon Kwon
- College of Medicine, Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kwang Y Paik
- College of Medicine, Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea -
| |
Collapse
|
|
2
|
Huang L, Yu Q, Peng H, Zhen Z. LigaSure technique for splenectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34719. [PMID: 37657000 PMCID: PMC10476714 DOI: 10.1097/md.0000000000034719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND This study aimed to clarify the optimal management of the LigaSure technique and conventional techniques during splenectomy. METHODS All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed, and Cochrane databases up to April 2023, were searched for relevant studies comparing the LigaSure technique with conventional techniques. Six studies, extracted by 2 independent reviewers, were evaluated for blood loss, operative time, conversion, mortality, hospital stay, and transfusion. RESULTS The blood loss was significantly higher in the convention group than in the LigaSure group (WMD = -48.98, 95% CI: -62.41 to -35.55, P < .00001). Meanwhile, the mean operative time was significantly shorter in LigaSure group than in convention group (WMD = -10.57; 95% CI: -12.35 to -8.78), P < .00001). No significant differences were found regarding the conversion rate, hospital stay, morbidity, and transfusion. CONCLUSIONS The LigaSure technique has comparable effects to conventional techniques, but to some extent reduces blood loss and operative time.
Collapse
Affiliation(s)
- Long Huang
- Department of No.1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Qingsheng Yu
- Department of No.1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Hui Peng
- Department of No.1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Zhou Zhen
- Department of Surgery, The Second Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei, China
| |
Collapse
|
|
3
|
Saouli A, Karmouni T, El Khader K, Koutani A, Attya Andaloussi AI. Total clipless laparoscopic nephrectomy carried out with the LigaSure device: Preliminary experience. Prog Urol 2023; 33:344-347. [PMID: 37080876 DOI: 10.1016/j.purol.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 02/24/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Total laparoscopic nephrectomy has become the standard method for the removal of diseased kidneys. OBJECTIVES The purpose of this study was to evaluate the feasibility of the LigaSure vessel closure system during laparoscopic nephrectomy. METHODS From January 2018 to June 2018, the LigaSure device was used in 5 patients undergoing laparoscopic nephrectomy for non functional kidney. Nephrectomy was carried out without the use of clips or sutures for vessel closure. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes. RESULTS Median operative time was 45minutes (range 25 to 60min). Median blood loss was 30mL (range 10 to 50mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. All patients left the hospital one day after the procedure. Histopathological examination of the removed kidneys was in favor of chronic non specific pyelonephritis. CONCLUSIONS For the treatment of the renal pedicle during total laparoscopic nephrectomy of a destroyed kidney, the LigaSure device appears to be feasible and effective. Our experience is the first to demonstrate the advantages of LigaSure® in laparoscopic nephrectomy: reduction in operating time, blood loss, transfusions and length of stay in hospital.
Collapse
Affiliation(s)
- Amine Saouli
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco.
| | - Tarik Karmouni
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
| | - Khalid El Khader
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
| | - Abdellatif Koutani
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
| | - Ahmed Iben Attya Andaloussi
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
| |
Collapse
|
|
4
|
Lasheen O, Yehia M, Salah A, Mikhail S, Hassan A. Towards cost saving in surgery without compromising safety: stapleless laparoscopic splenectomy in a developing country-a prospective cohort study. BMJ Open Qual 2023; 12:bmjoq-2022-002068. [PMID: 36707124 PMCID: PMC9884886 DOI: 10.1136/bmjoq-2022-002068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Minimally invasive surgery has been steadily growing in popularity. Control of splenic hilar vessels is the most delicate step during laparoscopic splenectomy (LS). In the earlier eras of LS, hilar vessels were controlled using clips and/or ligation. Laparoscopic staples were later introduced and have arguably led to an increase in popularity of LS. They do not abolish potential complications of splenectomy and theoretically represent an added operative cost.In this study, we aimed to assess the safety and efficacy of stapleless LS (using knots, haemostatic devices and clips) compared with the now more conventional stapled LS. METHODS A pilot randomised prospective study was conducted in a university hospital between September 2018 and April 2020. It included 40 patients randomly assigned to two equal groups: (1) 20 patients: stapleless LS and (2) 20 patients: LS using laparoscopic staples.We compared operative time, intra and postoperative complications and postoperative recovery. RESULTS There was no statistically significant difference between both groups across all comparative outcomes. CONCLUSION Both techniques are comparable in terms of safety and operative time. In terms of cost efficiency, we recommend more comprehensive analyses of hospital costs.
Collapse
Affiliation(s)
- Omar Lasheen
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Mohamed Yehia
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ayman Salah
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Sameh Mikhail
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ahmed Hassan
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| |
Collapse
|
|
5
|
Misiakos EP, Bagias G, Liakakos T, Machairas A. Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc 2017; 9:428-437. [PMID: 28979707 PMCID: PMC5605342 DOI: 10.4253/wjge.v9.i9.428] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/21/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes.
Collapse
Affiliation(s)
- Evangelos P Misiakos
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
| | - George Bagias
- Clinic for General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasios Machairas
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
| |
Collapse
|
|
6
|
Randomized clinical trial of ligasure™ versus conventional splenectomy for injured spleen in blunt abdominal trauma. Int J Surg 2016; 38:48-51. [PMID: 28034773 DOI: 10.1016/j.ijsu.2016.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Spleen is the most common organ damaged in cases of blunt abdominal trauma and splenectomy and splenorrhaphy are the main surgical procedures that are used in surgical treatment of such cases. In routine open splenectomy cases, after laparotomy, application of sutures in splenic vasculature is the most widely used procedure to cease the bleeding. This clinical trial evaluates the role and benefits of the Ligasure™ system in traumatic splenectomy without using any suture materials and compares the result with conventional method of splenectomy. METHODS After making decision for splenectomy secondary to a blunt abdominal trauma, patients in control group (39) underwent splenectomy using conventional method with silk suture ligation of splenic vasculature. In the interventional group (41) a Ligasure™ vascular sealing system was used for ligating of the splenic vein and artery. The results of operation time, volume of intra-operation bleeding and post-operative complications were compared in both groups. RESULTS The mean operation times in control and interventional group were 21 and 12 min respectively (p < 0.05). The average volume of bleeding in control group during open splenectomy was 280 cc, but in the interventional group decreased significantly to 80 ml (p < 0.05) using the Ligasure system. Post-operative complications such as bleeding were non-existent in both groups. CONCLUSION The application of Ligasure™ in blunt abdominal trauma for splenectomy not only can decrease the operation time but also can decrease the volume of bleeding during operation without any additional increase in post-operative complications. This method is recommendable in traumatic splenic injuries that require splenectomy in order to control the bleeding as opposed to use of traditional silk sutures.
Collapse
|
|
7
|
Olivieri P, Berkowitz R, Eaglstein E, Rose G, Siadecki S, Saul T. Diagnosis of Atypical Chest Pain Using Ultrasound. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316634030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While the common organs assessed in chest pain are the heart, lungs, and inferior vena cava, one must also consider other diagnoses. Splenic rupture can be either traumatic or atraumatic, and splenomegaly can make this vulnerable organ even more susceptible to injury. A case is reported of a patient who presented to the emergency department with a complaint of left-sided chest pain; a focused assessment with sonography for trauma (FAST) examination showed significant intraperitoneal free fluid consistent with splenic injury. The role of bedside sonography in acquiring a rapid and accurate diagnosis is discussed.
Collapse
Affiliation(s)
| | | | | | - Gabriel Rose
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA
| | | | - Turandot Saul
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA
| |
Collapse
|
|
8
|
Khirallah MG, Eldessoky NE, Elbatarny AM, Elsawaf ME. Laparoscopic splenectomy in children with benign hematological diseases: Leaving nothing behind policy. J Indian Assoc Pediatr Surg 2016; 21:14-8. [PMID: 26862289 PMCID: PMC4721122 DOI: 10.4103/0971-9261.164636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context: Laparoscopic splenectomy (LS) is considered the standard approach for the treatment of children with nonmalignant hematological diseases due to the advances in the minimal invasive surgery over the conventional splenectomy (CS). Different techniques are involved in the operation to secure the hilum. Aim: The use of (Ligasure™) is a safe, effective, less time consuming and with less complications rate. Materials and Methods: Sixty children (33 with thalassemia, 20 with immune thrombocytopenic purpura [ITP] and seven with spherocytosis) were operated during the period from June 2007 to December 2014. These children had undergone LS using (Ligasure™). Three ports were used in small-sized spleens while four ports were used in large spleens. Results: There were 60 children (37 girls and 23 boys) with a mean age of 10.2 years had LS using Ligasure™ with mean operative time of 85 min for cases of ITP and 120 min for other cases. There was no mortality. Two cases were converted to CS. Conclusions: Use of Ligasure™ alone was safe, less time consuming with less complications rates.
Collapse
|
|
9
|
Kanamoto M, Imura S, Morine Y, Utsunomiya T, Mori H, Arakawa Y, Takasu C, Shimada M. Effective use of a vessel-sealing system for laparoscopic unroofing of liver cysts. Asian J Endosc Surg 2015; 8:91-4. [PMID: 25598064 DOI: 10.1111/ases.12134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/07/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Liver cysts that present with symptoms such as jaundice, abdominal pain, and intra-cystic infection require treatment. In laparoscopic unroofing of liver cysts, appropriate treatment is needed in cases where the cystic walls contain vessels or bile ducts. A vessel-sealing system can seal not only vessels, but also bile ducts. We experienced four cases in which laparoscopic unroofing of liver cysts was performed with a vessel-sealing system. MATERIALS AND SURGICAL TECHNIQUE Case 1 was a woman in her 70s who presented at our hospital with abdominal pressure. Abdominal CT showed liver cysts with a maximum diameter of 13 cm. Laparoscopic unroofing was performed with LigaSure Impact. Case 2 was a woman in her 50s with abdominal discomfort. CT showed a cyst 15 cm in diameter situated in the right lobe. We performed SILS using a LigaSure Blunt Tip to unroof the cyst. Case 3 was a man in his 80s with abdominal pain. CT showed a huge cyst 25 cm in diameter in the right lobe. We performed hybrid SILS with a LigaSure Blunt Tip to unroof the cysts. Case 4 was a woman in her 70s with upper abdominal pain. CT showed multiple cysts with a maximum diameter of 15 cm in the bilateral lobes. We performed hybrid SILS to successfully unroof her cysts. None of the cases experienced postoperative complications, such as bleeding or bile leakage, and none experienced recurrence of cysts. DISCUSSION A laparoscopic unroofing using a vessel-sealing system can be a minimally invasive and safe treatment for liver cysts.
Collapse
Affiliation(s)
- Mami Kanamoto
- Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | | | | | | | | |
Collapse
|
|
10
|
Non-vascular experimental and clinical applications of advanced bipolar radiofrequency thermofusion technology in the thorax and abdomen: a systematic review. Surg Endosc 2014; 29:1659-78. [DOI: 10.1007/s00464-014-3893-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
|
|
11
|
Casaccia M, Stabilini C, Gianetta E, Ibatici A, Santori G. Current concepts of laparoscopic splenectomy in elective patients. World J Surg Proced 2014; 4:33-47. [DOI: 10.5412/wjsp.v4.i2.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/13/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Formerly, open splenectomy represented the conventional surgical treatment for many hematologic diseases. Currently, thanks to permanent technical development and improved skills, also laparoscopic splenectomy (LS) has become a recognized procedure in the treatment of spleen diseases, even in case of splenomegaly. A systematic review was performed with the aim of recalling the proved concepts of this surgical treatment and to browse new devices and techniques and their impact on the surgical outcome. The literature search was initially conducted in PubMed by entering general queries related to LS. The record identified through PubMed searching (n = 1599) was then screened by applying several criteria (study published in English from 1991 to 2013 with abstract available, by excluding systematic/non-systematic reviews, meta-analysis, practice guidelines, case reports, and study involving animals). The articles assessed for eligibility (n = 160) were primarily evaluated by excluding studies that did not report operative time and conversion to open surgery. For articles that treated multiport LS we included only clinical trials with patients > 20. The studies included in qualitative synthesis were 23. The search strategy carried out in PubMed does not allow to obtain an overview of the items returned by the main queries. With this aim we replicated the search in the Web of ScienceTM database, only including the studies published in English in the period 1991-2013 with no other filter/selection criteria. The full records (n = 1141) and cited references returned by Web of ScienceTM were analyzed with the visualization of similarities (VOS) mapping technique. Maps of title/abstract text corpus and bibliographic coupling of authors obtained by applying the VOS approach were presented. If in normal-size or moderately enlarged spleens the laparoscopic approach is unquestionable, in massive splenomegaly the optimal technique remain to be determined. In this setting, prospective randomized trials to compare open vs LS are needed. Between the new techniques of LS the robotic single port splenectomy has the ability to join all the positive aspects of both techniques. Data about this topic are too initial and need to be confirmed with further studies.
Collapse
|
|
12
|
Kim YN, Yoo YC, Guner A, Cho I, Kwon IG, Kim YN, Kim HI. Comparison of perioperative surgical outcomes between a bipolar device and an ultrasonic device during laparoscopic gastrectomy for gastric cancer. Surg Endosc 2014; 29:589-95. [DOI: 10.1007/s00464-014-3702-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/22/2014] [Indexed: 12/19/2022]
|
|
13
|
Fujita J, Takiguchi S, Nishikawa K, Kimura Y, Imamura H, Tamura S, Ebisui C, Kishi K, Fujitani K, Kurokawa Y, Mori M, Doki Y. Randomized controlled trial of the LigaSure vessel sealing system versus conventional open gastrectomy for gastric cancer. Surg Today 2014; 44:1723-9. [PMID: 24838660 DOI: 10.1007/s00595-014-0930-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/20/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE LigaSure, a bipolar electronic vessel sealing system, has become popular in abdominal surgery but few clinical studies have been conducted to evaluate its effectiveness in radical gastrectomy for gastric cancer. METHODS In this multicenter, prospective, randomized controlled trial, patients with curative gastric cancer were randomly assigned to undergo gastrectomy either with LigaSure or a conventional technique. RESULTS Of the 160 patients enrolled, 80 were randomized to the LigaSure group and 78 to the conventional group. Patient characteristics were well balanced in the two groups. There were no significant differences between the LigaSure and conventional groups in blood loss (288 vs. 260 ml, respectively; P = 0.748) or operative time (223 and 225 min, respectively; P = 0.368); nor in the incidence of surgical complications or duration of postoperative hospital stay. In a subgroup analysis of patients who underwent gastrectomy that preserved the distal part of the greater omentum, the use of LigaSure significantly reduced blood loss (179 vs. 245 ml; P = 0.033), and the duration of the operation (195 vs. 221 min; P = 0.039). CONCLUSIONS LigaSure did not contribute to reducing intraoperative blood loss, operative time, or other adverse surgical outcomes. The usefulness of the device may be limited to a specific part of the surgical procedure in open gastrectomy.
Collapse
Affiliation(s)
- Junya Fujita
- Department of Surgery, NTT West Osaka Hospital Osaka, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
14
|
Monarski CJ, Jaffe MH, Kass PH. Decreased Surgical Time with a Vessel Sealing Device Versus a Surgical Stapler in Performance of Canine Splenectomy. J Am Anim Hosp Assoc 2014; 50:42-5. [DOI: 10.5326/jaaha-ms-5981] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this retrospective study of 72 dogs was to compare a vessel sealing device with a surgical stapling device for performance of splenectomy. The results of this study demonstrate a statistically significant shorter surgical time for splenectomy, without an adverse effect on outcomes, performed in dogs with the vessel sealing device (mean time, 58.4 min ± 3.3 min; median time, 60 min; range, 22–131 min) compared with a traditional stapling device (mean time, 66.9 min ± 2.4 min; median time, 66 min; range, 40–100 min). No other significant differences were found between the two groups of patients.
Collapse
Affiliation(s)
- Christopher J. Monarski
- VCA Animal Referral and Emergency Center of Arizona, Mesa, AZ (C.M., M.J.); and Department of Population Health and Reproduction, University of California, Davis, CA (P.K.)
| | - Michael H. Jaffe
- VCA Animal Referral and Emergency Center of Arizona, Mesa, AZ (C.M., M.J.); and Department of Population Health and Reproduction, University of California, Davis, CA (P.K.)
| | - Phillip H. Kass
- VCA Animal Referral and Emergency Center of Arizona, Mesa, AZ (C.M., M.J.); and Department of Population Health and Reproduction, University of California, Davis, CA (P.K.)
| |
Collapse
|
|
15
|
Arya S, Hadjievangelou N, Lei S, Kudo H, Goldin RD, Darzi AW, Elson DS, Hanna GB. Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities. Surg Endosc 2013; 27:3485-96. [PMID: 23572219 DOI: 10.1007/s00464-013-2935-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/12/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bipolar radiofrequency (RF) induced tissue fusion is believed to have the potential to seal and anastomose intestinal tissue thereby providing an alternative to current techniques which are associated with technical and functional complications. This study examines the mechanical and cellular effects of RF energy and varying compressive pressures when applied to create ex vivo intestinal seals. METHODS A total of 299 mucosa-to-mucosa fusions were formed on ex vivo porcine small bowel segments using a prototype bipolar RF device powered by a closed-loop, feedback-controlled RF generator. Compressive pressures were increased at 0.05 MPa intervals from 0.00 to 0.49 MPa and RF energy was applied for a set time period to achieve bowel tissue fusion. Seal strength was subsequently assessed using burst pressure and tensile strength testing, whilst morphological changes were determined through light microscopy. To further identify the subcellular tissue changes that occur as a result of RF energy application, the collagen matrix in the fused area of a single bowel segment sealed at an optimal pressure was examined using transmission electron microscopy (TEM). RESULTS An optimal applied compressive pressure range was observed between 0.10 and 0.25 MPa. Light microscopy demonstrated a step change between fused and unfused tissues but was ineffective in distinguishing between pressure levels once tissues were sealed. Non uniform collagen damage was observed in the sealed tissue area using TEM, with some areas showing complete collagen denaturation and others showing none, despite the seal being complete. This finding has not been described previously in RF-fused tissue and may have implications for in vivo healing. CONCLUSIONS This study shows that both bipolar RF energy and optimal compressive pressures are needed to create strong intestinal seals. This finding suggests that RF fusion technology can be effectively applied for bowel sealing and may lead to the development of novel anastomosis tools.
Collapse
Affiliation(s)
- Shobhit Arya
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, 10th Floor, QEQM Building, South Wharf Road, London W2 1NY, UK.
| | | | | | | | | | | | | | | |
Collapse
|
|
16
|
Bai YN, Jiang H, Prasoon P. A meta-analysis of perioperative outcomes of laparoscopic splenectomy for hematological disorders. World J Surg 2013; 36:2349-58. [PMID: 22760851 DOI: 10.1007/s00268-012-1680-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Due to changes in surgical trends, laparoscopic splenectomy (LS) has become the standard approach for most splenectomies performed for hematological disorders, barring any contraindications. The perioperative outcomes of LS for this indication have not been updated for several years. Controversy still surrounds whether LS should be performed for massive splenomegaly. The purpose of this meta-analysis was to evaluate the perioperative outcomes of laparoscopic splenectomy for hematological disorders. METHODS Literature searches were conducted to identify studies comparing the perioperative outcomes of the laparoscopic and open approaches for hematological disorders. The results were pooled by using standard meta-analysis methods. RESULTS Thirty-eight studies with a total of 2,914 patients comparing LS to open splenectomy (OS) for hematological disorders were identified. Mortality was low in both groups. The pooled complications of the LS group were significantly fewer than those of the OS group (-0.11, p < 0.001), and the NNT was 9 (95 % confidence interval, 6-20). For massive spleens, a similar result was observed (-0.12, p = 0.009). Accessory spleen resection and blood loss also were comparable between the two approaches. Additionally, LS was associated with longer operative times (57.38 min, p < 0.00001) and shorter hospital stays (2.48 days, p < 0.00001). CONCLUSIONS LS is preferred compared to OS, based on lower complication rates and better handling of comorbid conditions. LS is associated with shorter hospital stays but longer operative times. We conclude that LS may be considered an acceptable option even in cases of a massive spleen. To strengthen the clinical evidence, more high-quality clinical trials on different issues are necessary.
Collapse
Affiliation(s)
- Yan-Nan Bai
- Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | | | | |
Collapse
|
|
17
|
Chen XD, He FQ, Yang L, Yu YY, Zhou ZG. Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review. ANZ J Surg 2012; 83:122-8. [PMID: 23170929 DOI: 10.1111/ans.12003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients. OBJECTIVES A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients. METHODS A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers. RESULTS Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization. CONCLUSIONS The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.
Collapse
Affiliation(s)
- Xiao-Dong Chen
- Department of Hepatobiliary-Gastrointestinal Surgery, Sichuan Cancer Hospital and Institute, Chengdu, China
| | | | | | | | | |
Collapse
|
|
18
|
Ji B, Liu Y, Zhang P, Wang Y, Wang G. A two-step control of secondary splenic pedicles using ligasure during laparoscopic splenectomy. Int J Med Sci 2012; 9:743-747. [PMID: 23136536 PMCID: PMC3491432 DOI: 10.7150/ijms.4862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We modified the LigaSure vessel sealing into a two-step technique without using Endo-GIA stapler for the secondary splenic pedicle control in laparoscopic splenectomy (LS). This study evaluated the efficacy and safety outcomes of this technique. METHODS Patients (n = 105) scheduled for elective LS were consecutively and prospectively enrolled, including 24 males and 81 females, with a mean age of 43.6 (range 11-75) years. Following the mobilization of the spleen, the splenic inflow was interrupted by applying a Hem-o-lock clip. LigaSure was used to seal and transect the secondary splenic pedicles adjacent to the pancreatic tail and subsequently in proximity to the spleen. RESULTS Of 105 patients, 103 patients (98.1%) underwent successful LS, whereas two patients (1.9%) required the conversion to laparotomy. The mean operative time was 100 min, whilst the mean volume of blood loss was 500 mL. No clinically significant morbidities or mortality occurred following LS. An average of 8,000 RMB (range: 6900 to 9000; 1 USD = 6.5 RMB) was saved by using this two-step technique. CONCLUSION Secondary splenic pedicles can be successfully controlled in LS by using a two-step technique with the LigaSure vessel sealing system in an economically favorable way.
Collapse
Affiliation(s)
| | | | | | | | - Guangyi Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Bethune Hospital, Jilin University, Jilin 130021, China
| |
Collapse
|
|
19
|
Abstract
Laparoscopic splenectomy (LS) is frequently performed for spleen removal under pathologic conditions. The aim of this study was to evaluate whether ligasure is superior to clip ligation during LS. In a simple randomized prospective study, 40 patients who were candidates for splenectomy were randomly assigned to 2 groups of clip and ligasure. Operating time, need for transfusion, intraoperative and postoperative bleeding, open conversion, and postoperative complications were evaluated. Operating time was 115.4 min (SD 15.24) in the clip group and 100.6 min (SD 16.05) in the ligasure group (P=0.005). Bleeding volume was 150.9 mL (SD 26.2) in the clip group and 131.7 mL (SD 25.1) in the ligasure group (P=0.025). In both groups, there was no need for transfusion and no conversion to the open approach. Although both clip and ligasure can be used for vascular control in LS, hemostasis is simply and easily achieved with little dissection using the ligasure method. Therefore, ligasure is superior to clip in cases of LS.
Collapse
|
|
20
|
Siracuse JJ, Saillant NN, Hauser CJ. Technological advancements in the care of the trauma patient. Eur J Trauma Emerg Surg 2012; 38:241-51. [PMID: 26815955 DOI: 10.1007/s00068-011-0160-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 10/15/2011] [Indexed: 12/11/2022]
Abstract
INTRODUTION Medical technology has benefited many types of patients, but trauma care has arguably benefited more from technologic development than almost any other field. METHODS A literature review to identify key technological advances in the care of trauma patients was performed. RESULTS The advances in trauma care are in great measure due to the integration of many different systems. Medical technology impacts care in the field at the site of the trauma, in the transport to trauma facilities, and care at the trauma center itself. Once at the hospital, technology has impacted care in the trauma bay, intensive care units, the operating room, and in postoperative and long-term care settings. The integration of advancements, however, needs to be examined in a careful systematic fashion to insure that patients will actually derive benefit.
Collapse
Affiliation(s)
- J J Siracuse
- Division of Acute Care Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
| | - N N Saillant
- Division of Acute Care Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
| | - C J Hauser
- Division of Acute Care Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA.
| |
Collapse
|
|
21
|
Ando K, Kurokawa T, Nagata H, Arikawa T, Yasuda A, Ito N, Kotake K, Nonami T. Laparoscopic surgery in the management of hypersplenism and esophagogastric varices: our initial experiences. Surg Innov 2012; 19:421-7. [PMID: 22298753 DOI: 10.1177/1553350611432724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Owing to recent advances in laparoscopic surgery, devascularization of the upper stomach with splenectomy (Spx) or Hassab's procedure (Has) as well as Spx for patients with portal hypertension have been attempted laparoscopically in some facilities, the results of which have been reported. This article describes the authors' surgical techniques and their results. METHODS Between August 1999 and August 2010, the authors treated 110 cases of portal hypertension with Spx or Has. Among these patients, 56 who simultaneously underwent additional major operations were eliminated from the study, leaving 54 patients eligible. They included 38 with open surgeries and 16 with laparoscopic surgeries, which consisted of 10 splenectomies and 6 Has operations. The perioperative data for the 2 groups were compared. RESULTS Purely laparoscopic Spx (L-Spx) was completed for 9 patients. Conversion from laparoscopic to hand-assisted laparoscopic surgery (HALS) was necessary for 1 patient because of poor visualization. Operative time was significantly longer in L-Spx than in the open method. Postoperative hospital stays were shorter for L-Spx. HALS was used for all 6 laparoscopic Has patients. There was no conversion from the laparoscopic to the open method. Operative time was significantly longer for laparoscopic Has than for open Has. Postoperative complication rates were significantly reduced, and postoperative hospital stays were significantly shorter for laparoscopic Has. CONCLUSIONS Although the data are still preliminary, laparoscopic surgery for patients with portal hypertension may prove to be a successful strategy.
Collapse
|
|
22
|
Dalvi AN, Thapar PM, Deshpande AA, Rege SA, Prabhu RY, Supe AN, Kamble RS. Laparoscopic splenectomy using conventional instruments. J Minim Access Surg 2011; 1:63-9. [PMID: 21206648 PMCID: PMC3004107 DOI: 10.4103/0972-9941.16529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 05/16/2005] [Indexed: 12/11/2022] Open
Abstract
Introduction: Laparoscopic splenectomy (LS) is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4), 197–200 (2004)], trauma [Ren et al., Surg Endosc 15(3), 324 (2001); Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4), 283–286 (2002)], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45), 847–852 (2002)]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. Materials and Methods: Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. Results: A total of 26 patients underwent LS. Twenty-two (85%) of patients had spleen size more than 500 g (average weight being 942.55 g). Mean operative time was 214 min (45–390 min). The conversion rate was 11.5% (n = 3). Average duration of stay was 5.65 days (3–30 days). Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. Conclusion: Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.
Collapse
Affiliation(s)
- A N Dalvi
- Department of General Surgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Mumbai, India
| | | | | | | | | | | | | |
Collapse
|
|
23
|
Single-incision laparoscopic splenectomy using the "tug-exposure technique" in adults: results of ten initial cases. Surg Endosc 2011; 25:3222-7. [PMID: 21512877 DOI: 10.1007/s00464-011-1697-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 03/28/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND The application of single-incision laparoscopic surgery (SILS) to splenectomy is still challenging with much room for technical improvement. The purpose of this study was to describe the tug-exposure technique, an innovative technique for performing safe single-incision laparoscopic splenectomy (SILS-Sp). METHODS We performed SILS-Sp in ten consecutive adult patients with a variety of pathology requiring total splenectomy. A SILS™ Port with three 5-mm trocars was placed in the umbilicus as a single-access site. A flexible 5-mm laparoscope and an articulating grasper were used in addition to standard laparoscopic equipment. A cloth tape was introduced intraperitoneally to encircle and tug the splenic hilum. Both ends of the tape were extracted through an extra needle hole in the skin. Pulling the tape in appropriate directions provided excellent exposure of the splenic hilum (the tug-exposure technique). Under sufficient tension and exposure by tugging the spleen, a linear stapler was introduced for stapling and dividing the splenic hilum and the splenic artery and vein. The spleen was extracted through the umbilical wound within a retrieval bag. The umbilical wound was closed with subcutaneous sutures. RESULTS The tug-exposure technique was successfully used in all patients and markedly improved the exposure of the splenic hilum during SILS-Sp. The median intraoperative blood loss was 15 (range 0-1,000) ml. Only one patient (10%) required conversion to open surgery. Median operative time was 230 (range, 150-378) min, the median extracted spleen weight was 260 (range, 100-580) g, and the median postoperative hospital stay was 7 (range, 4-9) days. All patients were discharged uneventfully. The umbilical incision was nearly invisible at the 1-month follow-up. CONCLUSIONS The tug-exposure technique is an innovative technique that enables easy and safe SILS splenectomy by experienced surgeons.
Collapse
|
|
24
|
Zarebczan B, Mohanty D, Chen H. A Comparison of the LigaSure and harmonic scalpel in thyroid surgery: a single institution review. Ann Surg Oncol 2011; 18:214-8. [PMID: 20853030 PMCID: PMC3019290 DOI: 10.1245/s10434-010-1334-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND During the last few years, many surgeons have begun to utilize the LigaSure device or Harmonic scalpel to perform thyroid surgery. Several papers have demonstrated the benefits of these devices compared with traditional hand-tying techniques. The purpose of this study was to examine our institution's experience with the LigaSure device and Harmonic scalpel during thyroid surgery and to compare mean operative times and complications associated with each device. METHODS A retrospective chart review was performed on all patients who underwent thyroid surgery using the LigaSure device or Harmonic scalpel at a single institution between December 2005 and August 2009. Charts were reviewed for patient demographics, mean operative time, length of stay, and complications, such as transient recurrent laryngeal nerve injury, hypocalcemia, and hematoma formation. RESULTS A total of 231 patients were included in the study, of whom 123 underwent total thyroidectomy and 108 underwent lobectomy. There was a significant decrease in the operative time for both thyroidectomies and lobectomies when the Harmonic scalpel was utilized. In regard to complications, there was no statistically significant difference in the number of transient and permanent recurrent laryngeal nerve injuries, percentage of patients developing hypocalcemia, or rate of hematoma development. CONCLUSION In this study, there was no difference in the rate of complications between the two devices. However, the use of the Harmonic scalpel significantly decreased operative time for both thyroidectomies and thyroid lobectomies compared with the LigaSure device.
Collapse
Affiliation(s)
- Barbara Zarebczan
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, USA
| | | | | |
Collapse
|
|
25
|
|
|
26
|
Minimizing intraoperative bleeding using a vessel-sealing system and splenic hilum hanging maneuver in laparoscopic splenectomy. ACTA ACUST UNITED AC 2010; 16:786-91. [PMID: 19779666 DOI: 10.1007/s00534-009-0175-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 08/25/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE The most common cause of conversion to laparotomy (open splenectomy) during laparoscopic splenectomy (LS) is bleeding from the splenic hilar vessels. Recently, the efficacy of Ligasure (a vessel-sealing system) as a safety device for sealing vessels and reducing intraoperative blood loss has been reported with various laparoscopic procedures. The objective of this report was to describe our techniques for minimizing bleeding during LS, characterized by the application of Ligasure (which reduces the number of clips and staples, and reduces unnecessary bleeding) and a splenic hilum hanging maneuver with a Diamond-Flex flexible retractor to obtain optimal exposure of the splenic hilum. METHODS We have performed 87 LSs since February 1993, and have employed the Ligasure instead of metal clips and staplers since September 2003. We have also introduced the splenic hilum hanging maneuver paired with Ligasure use. We have performed this new LS in 30 consecutive adult patients presenting with idiopathic thrombocytopenic purpura (n = 14), benign splenic tumor (n = 5), lymphoma (n = 4), hereditary spherocytosis (n = 2), liver cirrhosis (n = 2), and other pathologies (n = 3). The splenic ligaments and vessels, including the splenic artery and vein, were divided using a 5-mm Ligasure instead of a clip or stapler. The splenic hilum was encircled and elevated, using a Diamond-Flex, to ensure better exposure in all patients. RESULTS LS was successfully completed in 29 patients (97%), with only one conversion to open splenectomy. Mean blood loss for all patients with completed LS was only 21.6 ml (range 0-250 ml). Moreover, blood loss was not determinable (considered as 0 ml in this study) in 15 patients (52%). Mean spleen weight and operating time were 319.4 g (range 80-1605 g) and 143.4 min (range 90-180 min), respectively. No postoperative mortalities were encountered. Two patients experienced complications, including grade B pancreatic fistula and atelectasis, for an overall morbidity rate of 6.7%. Mean postoperative stay was 6.5 days (range 3-14 days). CONCLUSIONS LS using a Ligasure in combination with the splenic hilum hanging maneuver may reduce intraoperative blood loss.
Collapse
|
|
27
|
Clipless and Sutureless Laparoscopic Adrenalectomy Carried Out With the LigaSure Device in 32 Patients. Surg Laparosc Endosc Percutan Tech 2010; 20:109-13. [DOI: 10.1097/sle.0b013e3181ced190] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
28
|
The effects of LigaSure on the laparoscopic management of acute appendicitis: "LigaSure assisted laparoscopic appendectomy". Surg Laparosc Endosc Percutan Tech 2009; 19:333-5. [PMID: 19692885 DOI: 10.1097/sle.0b013e3181a99288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle. The aim of this study was to investigate the effect of LigaSure in laparoscopic appendectomy. Between August 2007 and June 2008, a total of 32 patients were included in the study. Patients were randomized into 2 groups. The first group's dissection of the mesoappendix was performed with LigaSure (5 to 10 mm), whereas the second group's with endodissector and endoclip. The surgical time, postoperative complications, additional analgesics use and hospital stay were compared. There were no significant differences in complication rates, use of analgesics and hospital stay between the groups. The operation time (49.06+/-14.73 min vs. 59.69+/-12.54 min, P=0.036) was significantly lower in the LigaSure group. This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely. However, more experiences are needed to attain reliable scientific results.
Collapse
|
|
29
|
Bansal N, Roberts WS, Apte SM, Lancaster JM, Wenham RM. Electrothermal bipolar coagulation decreases the rate of red blood cell transfusions for pelvic exenterations. J Surg Oncol 2009; 100:511-4. [PMID: 19697350 DOI: 10.1002/jso.21372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We evaluated whether electrothermal bipolar coagulation (Ligasure) for pelvic exenterations decreases operative morbidity. METHODS All cases of pelvic exenterations, for all malignancies, performed at Moffitt Cancer Center from 1999 to 2008, were identified through retrospective review of medical records. Estimated blood loss (EBL), transfusion, operative time, hospital stay, and complications were compared between Ligasure cases and non-Ligasure cases. RESULTS Seventy-five patients underwent identified. Ligasure was used in 29/75 (39%) cases and standard techniques in 46/75 (61%) cases. Primary malignancy was gynecologic in 31/75(40%) cases (18/29, 62% Ligasure cases, 13/46, 26% non-Ligasure cases). Patients undergoing gynecologic exenteration received fewer intraoperative packed red blood cell (PRBC) transfusions in the Ligasure group (mean = 2.8 U), compared to the non-Ligasure group (mean = 3.8 U; P < 0.0001). The EBL was less for Ligasure cases (1,815 ml vs. 2,205 ml; P = 0.4). For all patients, Ligasure cases had lower mean transfusion (2.7 U vs. 3.2 U; P = 0.32), and EBL (1,662 ml vs. 1,843 ml; P = 0.5). The mean operating time was similar (492 min vs. 502 min). There were no cases of re-operation for hemorrhage in either group. CONCLUSIONS Use of electrothermal bipolar coagulation for gynecologic exenterative surgery is associated with significantly lower blood transfusions, and may decrease blood loss and transfusion in non-gynecologic exenterative surgery.
Collapse
Affiliation(s)
- Nisha Bansal
- Division of Gynecological Oncology, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida 33612, USA
| | | | | | | | | |
Collapse
|
|
30
|
Abstract
OBJECTIVE The aim of this trial was to verify the new surgical device (the LigaSure vessels sealing system) decrease liver transection time. SUMMARY BACKGROUND DATA Among the major goals in hepatic resection are minimization of the operation time and of the blood loss. Preliminary reports have suggested that the vessel sealing system might decrease the liver transection time, which is directly associated with the amount of blood loss. METHODS Patients who were scheduled to undergo hepatic resection at the Tokyo University Hospital were assigned, by the minimization method, to either use of the new vessel sealing system (VS group) or the conventional clamp crushing method (CC group) for liver transection. The primary end point was the liver transection time, and the secondary endpoints were the amount of blood loss during the entire operation and during liver transection, length of hospital stay, postoperative liver function, and the incidence of various adverse events. An English-language summary of the protocol was submitted (registration ID: C000000337) to the Clinical Trials Registry managed by the University Hospital Medical Information Network in Japan, which can be accessed commission-free on the internet (Available at: http://www.umin.ac.jp/ctr/index.htm). RESULTS From February to December in 2006, a total of 165 patients underwent liver resection for some benign or malignant disease of the liver. Among these patients, 120 were randomly assigned to the CC (n = 60) or the VS (n = 60) group. There was no mortality in either of the 2 groups. The median liver transection time in the VS group was 57 minutes (range: 11-127), similar to that in the CC group (56 [range: 9-269] min, P = 0.64), while there was no difference in the transection speed between the 2 groups (1.16 [0.15-2.26] cm/min vs. 1.10 [0.15-2.66] cm/min, P = 0.95). The amount of blood loss and blood loss per transection area during liver transaction in the VS group was also similar to that in the CC group (median: 315 [25-2415] mL vs. 315 [10-1700] mL; P = 0.80) and (5.04 [1.01-44.2] mL/cm vs. 4.36 [0.15-50.5] mL/cm; P = 0.14), respectively. CONCLUSIONS This randomized controlled trial showed that while the vessel sealing system was safe, its use was not associated with any significant decrease of the operation time or blood loss during liver transaction as compared with that of the clamp crushing method.
Collapse
|
|
31
|
Stedile R, Beck CA, Schiochet F, Ferreira MP, Oliveira ST, Martens FB, Tessari JP, Bernades SB, Oliveira CS, Santos AP, Mello FP, Alievi MM, Muccillo MS. Laparoscopic versus open splenectomy in dogs. PESQUISA VETERINARIA BRASILEIRA 2009. [DOI: 10.1590/s0100-736x2009000800009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the last few years, the use of laparoscopy in veterinary medicine has expanded and consequently so was the need for studies that establish the advantages, disadvantages and possible complications of each procedure. The purpose of the current study was to describe a laparoscopic splenectomy technique and the alterations due to this access, and compare it to the open procedure in dogs. A total of 15 healthy female mongrel dogs were used, with mean weight of 17.4±2.5kg. The animals were distributed into three groups: Group IA of open splenectomy (laparotomy) using double ligation of the vessels of the splenic hilum with poliglicolic acid, Group IB of open splenectomy (laparotomy) with bipolar electrocoagulation of the splenic hilum, and Group II of laparoscopic access with bipolar electrocoagulation of the splenic hilum. Operative time, blood loss, size of incisions, complications during and after surgery were evaluated. Other parameters included pain scores, white blood cell (WBC) counts and postoperative serum concentrations of alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatine kinase (CK), C-reactive protein (CRP), glucose and cortisol. No differences were found in the evaluation of parameters between both open splenectomy techniques employed. Laparoscopic access presented significant differences (p<0,05) when compared with open surgery: Longer operative time, smaller abdominal access, decrease in blood loss, lower concentrations of CRP, higher levels of CK and ALP, and lower scores in the pain scale. Laparoscopic surgery showed fewer complications of the surgical wound. No significant differences were observed between groups in the postoperative temperature, WBC, ALT, cortisol and glucose concentrations. In conclusion, the laparoscopic technique is useful for splenectomy in dogs, being advantageous in terms of blood loss, surgical stress and surgical wounds. However, it expends more operative time and causes transitory increase in hepatic and muscular enzymes.
Collapse
|
|
32
|
Kawanaka H, Akahoshi T, Kinjo N, Konishi K, Yoshida D, Anegawa G, Yamaguchi S, Uehara H, Hashimoto N, Tsutsumi N, Tomikawa M, Koushi K, Harada N, Ikeda Y, Korenaga D, Takenaka K, Maehara Y. Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism. ACTA ACUST UNITED AC 2009; 16:749-57. [PMID: 19629372 DOI: 10.1007/s00534-009-0149-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension. METHODS From 1993 to 2008, 265 cirrhotic patients underwent LS. Child-Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or =1,000 mL), perisplenic collateral vessels, or Child-Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed. RESULTS There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients (P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min (P < 0.01) and from 506 to 171 g (P < 0.01), respectively. CONCLUSIONS With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.
Collapse
Affiliation(s)
- Hirofumi Kawanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
33
|
|
|
34
|
915MHz microwave ablation with high output power in in vivo porcine spleens. Eur J Radiol 2009; 75:87-90. [PMID: 19349134 DOI: 10.1016/j.ejrad.2009.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/18/2009] [Accepted: 03/06/2009] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of 915 MHz microwave (MW) ablation with high output power in in vivo porcine spleens. MATERIALS AND METHODS MW ablations were performed in 9 porcine spleens with an internally cooled 915 MHz antenna. Thermocouples were placed at 5, 10, 15, 20 mm away from the antenna to measure temperatures in real-time during MW emission. The energy was applied for 10 min at high output power of 60 W, 70 W or 80 W. Gross specimens were sectioned and measured to determine ablation size. Representative areas were examined by light microscopy and electron microscopy. Coagulation sizes and temperatures were compared among the three power groups. RESULTS Hematoxylin-eosin staining showed irreversible necrosis in the splenic coagulation area after MW ablation. As the power was increased, long-axis diameter enlarged significantly (p<.05). Short-axis diameter also tended to increase, but there were no statistical difference (p>.05). The coagulation size of long-axis and short-axis diameter with 80 W in vivo spleen ablation was 6.43+/-0.52 and 4.95+/-0.30 cm, respectively. With the increase of output power, maximum temperatures at 5, 10, 15, 20 mm from the antenna were increased accordingly (p<.05). The maximum temperature with 80 W at 5 and 20 mm from the antenna reached 146.17+/-6.65 and 72.38+/-4.23 degrees C respectively. CONCLUSION With internally cooled antenna and high output power, 915 MHz MW ablation in the spleen could produce irreversible tissue necrosis of clinical significance. MW ablation may be used as a promising minimally invasive method for the treatment of splenic diseases.
Collapse
|
|
35
|
Xu WL, Li SL, Wang Y, Li M, Niu AG. Role of color Doppler flow imaging in applicable anatomy of spleen vessels. World J Gastroenterol 2009; 15:607-11. [PMID: 19195064 PMCID: PMC2653353 DOI: 10.3748/wjg.15.607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the role of color Doppler flow imaging (CDFI) in visualization of spleen vessels and to define its value for spleen micro-invasive operation.
METHODS: A total of 36 patients requiring laparoscopic splenectomy (LS) for various hematopathies and autoimmune diseases were randomly selected from April 2005 to May 2008. Anatomic types of spleen pedicle, adjacent relations between spleen vessels and pancreas, diameters of spleen artery and vein were detected and recorded by preoperative CDFI. Different operative procedures were performed according to different anatomic frameworks. The parameters were recorded by telerecording during LS and compared with those by preoperative CDFI using Chi-square test.
RESULTS: Two anatomic types of spleen pedicle and four different adjacent relations between spleen vessels and pancreas were detected by CDFI. The diameters of spleen artery and vein detected by CDFI were 0.46 ± 0.09 cm and 0.85 ± 0.35 cm, respectively. There was no statistical difference between the parameters recorded by CDFI and by telerecording (χ2 = 0.250, 0.677, P > 0.05). LS was successfully performed following the anatomic information provided by preoperative CDFI.
CONCLUSION: Different anatomic frameworks of spleen vessels can be provided by preoperative CDFI, which instructs micro-invasive operation of spleen and increase the safety of operation.
Collapse
|
|
36
|
Laparoscopic Splenectomy Using LigaSure in Benign Hematologic Diseases. Surg Laparosc Endosc Percutan Tech 2009; 19:69-71. [DOI: 10.1097/sle.0b013e318180a529] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
37
|
Manouras A, Markogiannakis HE, Kekis PB, Lagoudianakis EE, Fleming B. Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel. Expert Rev Med Devices 2008; 5:447-66. [PMID: 18573045 DOI: 10.1586/17434440.5.4.447] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar vessel sealing system and ultrasonically activated shears, have been developed and have been welcome adjuncts to the thyroid surgeon's armamentarium. In this review we aim to cover both novel and well-established traditional techniques of hemostasis in thyroid surgery, with specific focus on the bipolar vessel sealer and harmonic scalpel.
Collapse
Affiliation(s)
- Andreas Manouras
- Department of Endocrine Surgery, 1st Department of Propaedeutic Surgery, Hippocration Hospital, Athens Medical School, University of Athens, Vas. Sofias 114 Avenue, Athens, Greece.
| | | | | | | | | |
Collapse
|
|
38
|
Abstract
For years splenectomy in hepatic disorders has been indicated only for the treatment of gastro-esophageal varices. However, with recent advances in medical and surgical treatments for chronic hepatic disorders, the use of splenectomy has been greatly expanded, such that splenectomy is used for reversing hypersplenism, for applying interferon treatment for hepatitis C, for treating hyperdynamic portal circulation associated with intractable ascites, and for controlling portal pressure during small grafts in living donor liver transplantation. Such experiences have shown the importance of portal hemodynamics, even in cirrhotic livers. Recent advances in surgical techniques have enabled surgeons to perform splenectomy more safely and less invasively, but the procedure still has considerable clinical outcomes. Splenectomy in hepatic disorders may become a more common procedure with expanded indications. However, it should also be noted that the long-term effects of splenectomy, in terms of improved hematological or hepatic function, is still not guaranteed. Moreover, the impact of splenectomy on immunologic status remains unclear and needs to be elucidated in both experimental and clinical settings.
Collapse
Affiliation(s)
- Toru Ikegami
- The Department of Surgery, the University of Tokushima, Tokushima, Japan
| | | | | |
Collapse
|
|
39
|
Hama T, Takifuji K, Uchiyama K, Tani M, Kawai M, Yamaue H. Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension. ACTA ACUST UNITED AC 2008; 15:304-9. [PMID: 18535769 DOI: 10.1007/s00534-007-1232-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 06/03/2007] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE This study was conducted retrospectively to examine whether laparoscopic splenectomy is an effective procedure for patients with splenomegaly due to portal hypertension in comparison to patients with a normal-sized spleen. METHODS From September 1994 to May 2005, we performed laparoscopic splenectomy in 50 patients at Wakayama Medical University Hospital, Japan. Of these, 17 patients with splenomegaly due to portal hypertension and 17 patients with idiopathic thrombocytopenic purpura (ITP) with normal-size spleen were enrolled in this study, in which we compared the surgical outcome between patients with splenomegaly due to portal hypertension and those without splenomegaly (ITP group). RESULTS The mean operative time (splenomegaly due to portal hypertension vs ITP; 171 vs 165 min; P = 0.7433) and estimated blood loss (248 vs 258 ml; P = 0.5396) were similar in the two groups. There were two patients with complications (11.8%) in the patients with splenomegaly due to portal hypertension and five patients with complications (29.4%) in those with ITP. All patients with splenomegaly due to portal hypertension showed appropriate increases in the platelet count following surgery. No perioperative mortality occurred. CONCLUSIONS We concluded that laparoscopic splenectomy was an effective procedure for splenomegaly due to portal hypertension, with findings being similar to those observed in patients with a normal-sized spleen (such as patients with ITP).
Collapse
Affiliation(s)
- Takashi Hama
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | | | | | | | | | | |
Collapse
|
|
40
|
Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2008; 22:821-48. [PMID: 18293036 DOI: 10.1007/s00464-007-9735-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 11/23/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude laparoscopic splenectomy are not clearly defined. In view of this, the European Association for Endoscopic Surgery (EAES) has developed clinical practice guidelines for LS. METHODS An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. A consensus development conference using a nominal group process convened in May 2007. Its recommendations were presented at the annual EAES congress in Athens, Greece, on 5 July 2007 for discussion and further input. After a further Delphi process between the experts, the final recommendations were agreed upon. RESULTS Laparoscopic splenectomy is indicated for most benign and malignant hematologic diseases independently of the patient's age and body weight. Preoperative investigation is recommended for obtaining information on spleen size and volume as well as the presence of accessory splenic tissue. Preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections is recommended in elective cases. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and prolonged anticoagulant prophylaxis to high-risk patients. The choice of approach (supine [anterior], semilateral or lateral) is left to the surgeon's preference and concomitant conditions. In cases of massive splenomegaly, the hand-assisted technique should be considered to avoid conversion to open surgery and to reduce complication rates. The expert panel still considered portal hypertension and major medical comorbidities as contraindications to LS. CONCLUSION Despite a lack of level 1 evidence, LS is a safe and advantageous procedure in experienced hands that has displaced open surgery for almost all indications. To support the clinical evidence, further randomized controlled trials on different issues are mandatory.
Collapse
Affiliation(s)
- B Habermalz
- Institute for Research in Operative Medicine, University Witten/Herdecke, Witten/Herdecke, IFOM, Ostmerheimer Strasse 200, 51109, Köln, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
41
|
Manouras A, Markogiannakis H, Koutras AS, Antonakis PT, Drimousis P, Lagoudianakis EE, Kekis P, Genetzakis M, Koutsoumanis K, Bramis I. Thyroid surgery: comparison between the electrothermal bipolar vessel sealing system, harmonic scalpel, and classic suture ligation. Am J Surg 2008; 195:48-52. [PMID: 18082542 DOI: 10.1016/j.amjsurg.2007.01.037] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 01/20/2007] [Accepted: 01/20/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study was conducted to compare the outcome of total thyroidectomy using the electrothermal bipolar vessel sealing system, the harmonic scalpel, and the classic suture ligation technique. METHODS This was a retrospective study of prospectively collected data from 382 consecutive total thyroidectomies from September 2004 to August 2006. Patients were divided into 3 groups: group SL patients (n = 90) underwent total thyroidectomy with the classic suture ligation technique, group L (n = 148) with the electrothermal bipolar vessel sealer, and group U (n = 144) with the harmonic scalpel. The main outcomes measured were surgical and hospitalization time, intraoperative and postoperative bleeding, postoperative hypocalcemia, and superior and inferior laryngeal nerves injuries. RESULTS The 3 groups were similar in terms of demographics, thyroid gland weight and pathology, perioperative complications, and hospital stay. Compared with the classic technique, surgical time was reduced significantly by about 20% when the bipolar vessel sealer or harmonic scalpel was used (93.3 +/- 12.5 vs 74.3 +/- 14.2 and 73.8 +/- 13.8 min, P = .001, and P = .001, respectively). CONCLUSIONS Both the bipolar vessel sealer and harmonic scalpel are safe, useful, and time-saving alternatives to the traditional suture ligation technique for thyroid surgery. Because no differences were observed regarding these 2 devices, the choice should be made based on the surgeon's preferences and experience.
Collapse
Affiliation(s)
- Andreas Manouras
- Endocrine Surgery Unit, First Department of Propaedeutic Surgery, Athens Medical School, University of Athens, Hippokrateion Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
42
|
Santini M, Vicidomini G, Fiorello A, Laperuta P, Busiello L. Electrothermal bipolar tissue sealing systems in lung surgery. Multimed Man Cardiothorac Surg 2008; 2008:mmcts.2007.003111. [PMID: 24415670 DOI: 10.1510/mmcts.2007.003111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Various techniques have been proposed to reduce intraoperative blood loss in surgery. We report our experience with the use of LigaSure, a new electrothermal bipolar tissue sealing system, in lung surgery. This system has been already applied with good results in other surgical fields. However, the experience reported in the literature with the use of this technique in lung surgery is limited. Our clinical series with LigaSure (160 procedures in a 4-year period) is the largest reported to date. Technical aspects, clinical results and an overview of the literature are presented. We believe that LigaSure is an easy and safe technique, suitable for lung surgery. It could be a valid alternative or complement to staplers for several procedures, also in the thoracoscopic setting. Furthermore, it seems to allow functional lung tissue preservation and reduction of surgical supplies costs.
Collapse
Affiliation(s)
- Mario Santini
- Thoracic Surgery, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | | | | | | | | |
Collapse
|
|
43
|
Kössi J, Luostarinen M, Kontula I, Laato M. Laparoscopic Sigmoid and Rectal Resection Using an Electrothermal Bipolar Vessel Sealing Device. J Laparoendosc Adv Surg Tech A 2007; 17:719-22. [DOI: 10.1089/lap.2006.0238] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jyrki Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Ilpo Kontula
- Department of Surgery, Kuusankoski District Hospital, Kuusankoski, Finland
| | - Matti Laato
- Department of Surgery, University of Turku, Turku, Finland
| |
Collapse
|
|
44
|
Demirturk F, Aytan H, Caliskan AC. Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy. J Obstet Gynaecol Res 2007; 33:341-5. [PMID: 17578364 DOI: 10.1111/j.1447-0756.2007.00533.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. METHODS A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. RESULTS Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 +/- 3.71 vs 90.95 +/- 5.73 min, P < 0.001; 87.76 +/- 25.48 vs 152.63 +/- 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. CONCLUSION EBVS was found to be less time-consuming and caused less bleeding when compared with HS.
Collapse
Affiliation(s)
- Fazli Demirturk
- Gaziosmanpasa University, Faculty of Medicine, Department of Obstetrics and Gynecology, Tokat, Turkey
| | | | | |
Collapse
|
|
45
|
Wong K, Tam P. Ligasure vessel sealing system in laparoscopic Palomo varicocele ligation in children and adolescents: much ado about nothing. J Laparoendosc Adv Surg Tech A 2007; 17:707. [PMID: 17907995 DOI: 10.1089/lap.2007.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
|
46
|
Guerrieri M, Crosta F, De Sanctis A, Baldarelli M, Lezoche G, Campagnacci R. Use of the electrothermal bipolar vessel system (EBVS) in laparoscopic adrenalectomy: a prospective study. Surg Endosc 2007; 22:141-5. [PMID: 17479312 DOI: 10.1007/s00464-007-9390-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 01/04/2007] [Accepted: 01/27/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since laparoscopic adrenalectomy (LA) has been adopted as the gold standard for the treatment of adrenal diseases, the development of technology for vascular control and dissection manoeuvres, amongst other things, may play a pivotal role in its further improvement. We report our experience with the electrothermal bipolar vessel sealing (EBVS) device for LA. METHODS From January 2004 to January 2006, 50 patients (pts) undergoing LA were selected and randomized for use of the EBVS (25 pts, group A) versus the UltraSonic Shears (USS) device (25 pts, group B). Age, sex, body mass index (BMI), previous surgery and associated diseases were similar between the two groups. The main surgical parameters collected for each patient (pt) concerned operative time, major and minor complications, conversion rate, blood loss, hospital stay and histology. RESULTS There was no mortality in either group. The right adrenalectomy mean operative time (OpT) was 51.8 mins (range 40-90 mins) and 68.6 mins (range 50-130 mins) in group A and B, respectively (P not significant). The left adrenalectomy mean OpT was 72.2 mins (range 55-100 mins) and 94 mins (range 65-140 mins) for group A and B, respectively (P < 0.05). The mean blood loss was 83 ml (group A) and 210 ml (group B) (p < 0.05). Complications were not different for the two groups. The mean hospital stay was 2.9 and 3.1 days in group A and B, respectively (P not significant). CONCLUSIONS EBVS in LA may provide a significantly short operating time and blood loss.
Collapse
Affiliation(s)
- Mario Guerrieri
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti, 60121, Ancona, Italy
| | | | | | | | | | | |
Collapse
|
|
47
|
Romano F, Garancini M, Caprotti R, Bovo G, Conti M, Perego E, Uggeri F. Hepatic resection using a bipolar vessel sealing device: technical and histological analysis. HPB (Oxford) 2007; 9:339-44. [PMID: 18345316 PMCID: PMC2225510 DOI: 10.1080/13651820701504181] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Blood loss and bile leakage are well-known risk factors for morbidity and mortality during liver resection. Bleeding usually occurs during parenchymal transection, and surgical technique should be considered an important factor in preventing intraoperative and postoperative complications. OBJECTIVE Many approaches and devices have been developed to limit bleeding and bile leakage. The aim of the present study was to determine whether a bipolar vessel sealing device allows a safe and careful liver transection without routine inflow occlusion, achieving a satisfactory hemostasis and bile stasis, thus reducing blood loss and bile leak and related complications. PATIENTS AND METHODS A total of 50 consecutive patients (24 males, 26 females, with a mean age of 57 years) underwent major and minor hepatic resections using a bipolar vessel sealing device. A clamp crushing technique followed by energy application was used to perform the parenchymal transection. Inflow occlusion was used when necessary to control blood loss but not as a routine. No other devices were applied to achieve hemostasis. RESULTS The instrument was effective in 45 patients and failed to achieve hemostasis in 5 cases, all of whom had a cirrhotic liver. Median blood loss was 490 ml (range 100-2500 ml) and intraoperative blood transfusions were required in eight cases (16%). Mean operative time was 178 min (range 50-315 min). Inflow occlusion was necessary in 16 (32%) patients. The postoperative complication rate was 24%, with a postoperative hemorrhage in a cirrhotic patient. There was no clinical evidence of bile leak or procedure-related abdominal abscess. CONCLUSION We conclude that the device is a useful tool in standard liver resection, achieving good hemostasis and bile stasis in patients with normal liver parenchyma, but its use should be avoided in cirrhotic patients.
Collapse
Affiliation(s)
- Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy.
| | | | | | | | | | | | | |
Collapse
|
|
48
|
Diamantis T, Kontos M, Arvelakis A, Syroukis S, Koronarchis D, Papalois A, Agapitos E, Bastounis E, Lazaris AC. Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure. Surg Today 2006; 36:908-13. [PMID: 16998685 DOI: 10.1007/s00595-006-3254-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Accepted: 03/14/2006] [Indexed: 02/06/2023]
Abstract
PURPOSE Hemostasis is a fundamental principle of surgery. We compared the safety and efficacy of monopolar electrocoagulation (ME), bipolar electrocoagulation (BE), Ligasure (LS), a modern bipolar vessel sealing system, and Ultracision (UC), a system of ultrasound energy based shears. We also studied the healing process after their use. METHODS We used each of the above methods to coagulate and divide the short gastric vessels of 16 white male New Zealand rabbits. The animals were killed after 3, 7, 14, or 21 days, and the coagulation sites and the adjacent gastric wall were examined histologically. RESULTS LS and UC achieved complete hemostasis without any complications. Conversely, ME and BE often resulted in failed coagulation and perforation of the neighboring gastric wall from a side thermal injury. Histologically, LS demonstrated the mildest side thermal injury and the fastest healing process. We noted greater thermal injury and inflammatory response after UC than after LS on days 7 and 14; however, ME and BE caused the most severe lesions. CONCLUSIONS LS and UC are clearly the safest and most efficient methods of coagulation, whereas ME and BE could cause serious clinical and histological complications. We found histological evidence that UC causes a slightly greater inflammatory response than LS, and the clinical implications of this warrant further investigation.
Collapse
Affiliation(s)
- Theodore Diamantis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
|
49
|
Romano F, Caprotti R, Conti M, Piacentini MG, Uggeri F, Motta V, Pogliani EM, Uggeri F. Thrombosis of the splenoportal axis after splenectomy. Langenbecks Arch Surg 2006; 391:483-8. [PMID: 16909290 DOI: 10.1007/s00423-006-0075-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Accepted: 05/10/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Thrombosis of the portal system is a potentially life-threatening complication after splenectomy. The reported incidence is low (approximately or = 1%), however may be underestimated due to difficult in making the diagnosis. The factors associated with its development and the clinical outcome are poorly characterized. The aim of this study was to assess the incidence, risk factors, treatment, and outcome in series of consecutive cases. MATERIALS AND METHODS All patients who had undergone a splenectomy (both open and laparoscopic) between January 1997 and December 2004 at the Department of Surgery of University of Milan Bicocca were retrospectively reviewed. Twelve cases of thrombosis (7.6%) among 158 splenectomies were identified. No significant differences were noted in age, gender, and surgical approach between patients who developed thrombosis and those who did not. Indication for splenectomy in patients with thrombosis were myeloproliferative disorders (n=5), hemolytic disease (n=4), and lymphoproliferative disorder (n=3). All patients had splenomegaly (mean 1.380 kg, range 0.400-3.120 kg). RESULTS Among patients with myeloproliferative disorders, five (33%) developed the complication, compared with 4 of 35 (11.5%) with hemolytic disease. Patients with both splenic weight >2.500 kg and myeloproliferative disorders had 80% incidence of portal thrombosis. Preoperative prophylactic anticoagulant therapy with low molecular weight heparin was administered in each case. All these patients had fever, abdominal pain, or leukocytosis. All diagnoses were made by contrast-enhanced computed tomography (CT) scan and ecocolordoppler ultrasonography, and anticoagulation therapy was initiated immediately. Treatment within 15 days after splenectomy was successful in all patients, while delayed treatment was ineffective. CONCLUSIONS Portal thrombosis should be suspected in patients with fever or abdominal pain after splenectomy. Patients with myeloproliferative disorders and hemolytic diseases are at higher risk, as well as patients with marked splenomegaly. A high index of suspicion, early diagnosis, and prompt anticoagulation therapy are the keys to a successful outcome.
Collapse
Affiliation(s)
- Fabrizio Romano
- Department of Surgery (Chirurgia I), San Gerardo Hospital, II University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
|
50
|
Ohta M, Nishizaki T, Matsumoto T, Shimabukuro R, Sasaki A, Shibata K, Matsusaka T, Kitano S. Analysis of risk factors for massive intraoperative bleeding during laparoscopic splenectomy. ACTA ACUST UNITED AC 2006; 12:433-7. [PMID: 16365814 DOI: 10.1007/s00534-005-1027-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 02/28/2005] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Laparoscopic splenectomy is occasionally converted to open surgery due to massive intraoperative bleeding. The aim of this study was to identify the risk factors for massive bleeding during laparoscopic splenectomy. METHODS Fifty-three patients underwent laparoscopic splenectomy. The indications were hematologic disease in 25 patients, liver cirrhosis in 17 patients, and other conditions in 11 patients. Univariate analysis was conducted with Fisher's exact test, and multivariate analysis was conducted with a stepwise logistic regression model. RESULTS None of the patients required open surgery. Blood loss of more than 800 ml was defined as massive intraoperative bleeding. Univariate analysis showed significant risk factors for massive bleeding to be liver cirrhosis, portal hypertension, splenomegaly, Child class, and preoperative platelet count. Independent risk factors in the multivariate analysis were portal hypertension and Child class. CONCLUSIONS Careful attention to intraoperative bleeding during laparoscopic splenectomy is necessary for patients with portal hypertension and/or deteriorated liver function.
Collapse
Affiliation(s)
- Masayuki Ohta
- First Department of Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | | | | | | | | | | | | | | |
Collapse
|