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Zhu C, Na Y, Cheng X, Tao X, Xie P, Chen L, Zhao H, Qiu J, Gu X, Xiang J, Liu K. Assessing the influence of parameters on tissue welding in small bowel end-to-end anastomosis in vitro and in vivo. Surg Endosc 2024; 38:3126-3137. [PMID: 38622226 DOI: 10.1007/s00464-024-10795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/09/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The use of high-frequency electric welding technology for intestinal end-to-end anastomosis holds significant promise. Past studies have focused on in vitro, and the safety and efficacy of this technology is uncertain, severely limiting the clinical application of this technology. This study investigates the impact of compression pressure, energy dosage, and duration on anastomotic quality using a homemade anastomosis device in both in vitro and in vivo settings. METHODS Two hundred eighty intestines and 5 experimental pigs were used for in vitro and in vivo experiments, respectively. The in vitro experiments were conducted to study the effects of initial pressure (50-400 kpa), voltage (40-60 V), and time (10-20 s) on burst pressure, breaking strength, thermal damage, and histopathological microstructure of the anastomosis. Optimal parameters were then inlaid into a homemade anastomosis and used for in vivo experiments to study the postoperative porcine survival rate and the pathological structure of the tissues at the anastomosis and the characteristics of the collagen fibers. RESULTS The anastomotic strength was highest when the compression pressure was 250 kPa, the voltage was 60 V, and the time was 15 s. The degree of thermal damage to the surrounding tissues was the lowest. The experimental pigs had no adverse reactions after the operation, and the survival rate was 100%. 30 days after the operation, the surgical site healed well, and the tissues at the anastomosis changed from immediate adhesions to permanent connections. CONCLUSION High-frequency electric welding technology has a certain degree of safety and effectiveness. It has the potential to replace the stapler anastomosis in future and become the next generation of new anastomosis device.
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Affiliation(s)
- Caihui Zhu
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yuyan Na
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiujun Cheng
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaonan Tao
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Pengyao Xie
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Lei Chen
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Hui Zhao
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Jian Qiu
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Xiaodong Gu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianbin Xiang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kefu Liu
- School of Information Science and Technology, Fudan University, Shanghai, China.
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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.
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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
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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.
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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
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Giglio NC, Grose HM, Fried NM. Reciprocating Side-Firing Fiber for Laser Sealing of Blood Vessels. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 11936:1193602. [PMID: 35965612 PMCID: PMC9375160 DOI: 10.1117/12.2605599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Infrared lasers may provide faster and more precise sealing of blood vessels and with lower jaw temperatures than ultrasonic and electrosurgical devices. This study explores an oscillating or reciprocating side-firing optical fiber method for transformation of a circular laser beam into a linear beam, necessary for integration into a standard 5-mm-diameter laparoscopic device, and for uniform irradiation perpendicular to the vessel length. A servo motor connected to a side-firing, 550-μm-core fiber, provided linear translation of a 2.0-mm-diameter circular beam over either 5 mm or 11 mm scan lengths for sealing small or large vessels, respectively. Laser seals were performed, ex vivo, on a total of 20 porcine renal arteries of 1-6 mm diameter (n = 10 samples for each scan length). Each vessel was compressed to a fixed 0.4-mm-thickness, matching the 1470-nm laser optical penetration depth. Vessels were irradiated with fluences ranging from 636 J/cm2 to 716 J/cm2. A standard burst pressure (BP) setup was used to evaluate vessel seal strength. The reciprocating fiber produced mean BP of 554 ± 142 and 524 ± 132 mmHg, respectively, and consistently sealing blood vessels, with all BP above hypertensive (180 mmHg) blood pressures. The reciprocating fiber provides a relatively uniform linear beam profile and aspect ratio, but will require integration of servo motor into a handpiece.
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Affiliation(s)
- Nicholas C Giglio
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
| | - Haleigh M Grose
- Department of Mechanical Engineering, University of North Carolina at Charlotte, NC
| | - Nathaniel M Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
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Giglio NC, Fried NM. Computational Simulations for Infrared Laser Sealing and Cutting of Blood Vessels. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2021; 27:1-8. [PMID: 33746498 PMCID: PMC7978229 DOI: 10.1109/jstqe.2020.3045912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Blood vessel burst pressures were simulated and predicted for sealing and cutting of vessels in a two-step process, using low (<25 W), medium (~100 W), and high (200 W) power lasers at a wavelength of 1470 nm. Monte Carlo optical transport, heat transfer, Arrhenius integral tissue damage simulations, and vessel pressure equations were utilized. The purpose of these studies was to first validate the numerical model by comparison with experimental results (for low and medium power) and then to use the model to simulate parameters that could not be experimentally tested (for high power). The goal was to reduce the large range of parameters (power, irradiation time, and linear beam dimensions) to be tested in future experiments, for achieving short vessel sealing/cutting times, minimal bifurcated seal zones (BSZ), and high vessel burst pressures. Blood vessels were compressed to 400 μm thickness. A wide range of linear beam profiles (1-5 mm widths and 8-9.5 mm lengths), incident powers (20-200 W) and clinically relevant irradiation times (0.5-5.0 s) were simulated and peak seal and cut temperatures as well as thermal seal zones, ablation zones, and BSZ computed. A simplistic mathematical expression was used to estimate vessel burst pressures based on seal width. Optimal low-power parameters were: 24W/5s/8×2mm (sealing) and 24W/5s/8×1mm (cutting), yielding a BSZ of 0.4 mm, corresponding to experimental burst pressures of ~450 mmHg. Optimal medium-power parameters were: 90W/1s/9.5×3mm (sealing) and 90W/1s/9.5×1mm (cutting), yielding a BSZ of 0.9 mm for burst pressures of ~1300 mmHg. Simulated only optimal high-power parameters were: 200W/0.5s/9×3 mm (sealing) and 200W/0.5s/9×1mm (cutting), yielding a BSZ of 0.9 mm and extrapolated to predict a seal strength of ~1300 mmHg. All lasers produced seal zones between 0.4-1.5 mm, corresponding to high vessel burst pressures of 300-1300 mmHg (well above normal systolic blood pressure of 120 mmHg). Higher laser powers enable shorter sealing/cutting times and higher vessel strengths.
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Affiliation(s)
- Nicholas C Giglio
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, NC 28223 USA
| | - Nathaniel M Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, NC 28223 USA
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Bahoush G, Nojoomi M. A Study on the Efficacy of Empirical Antibiotic Therapy for Splenectomized Children with Fever. J Med Life 2020; 13:151-155. [PMID: 32742506 PMCID: PMC7378339 DOI: 10.25122/jml-2019-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thalassemia represents a heterogeneous group of inherited diseases characterized by the lack or reduced production of hemoglobin β-chains. Many patients with thalassemia require splenectomy. What should be considered in the evaluation and management of candidates for splenectomy is to cover vaccination against infections such as pneumococci and the implementation of antibiotic prophylaxis. This study aimed to investigate the effect of the antibiotic type on the outcome of acute post-splenectomy infection in patients with thalassemia. This investigation is a retrospective cohort study. One hundred fifty medical records of hemoglobinopathy patients who underwent splenectomy were collected from the Ali-Asghar Hospital, Tehran, Iran. SPSS v. 20 and SAS v. 1.9 were used to analyze the data. A total of 150 patients that were vaccinated against post-splenectomy infections and were under antibiotic prophylaxis underwent splenectomy. The most commonly prescribed drugs were ceftriaxone or cefotaxime (132 cases, 88%), followed by ceftriaxone plus clindamycin (5.3%), ceftriaxone plus amikacin (3.3%), clindamycin (1.3%), vancomycin plus amikacin (0.7%), and others (1.3%). In terms of treatment outcomes, 143 cases (95.3%) were treated with the same antibiotics, and 4 (2.7%) experienced a changed antibiotic regimen with vancomycin. The results show that perceptions of treatment for fever in splenectomized children need to be changed, and most of them do not require hospitalization and initiation of broad-spectrum antibiotics such as vancomycin for initially refractory cases, and can only be treated with daily intravenous ceftriaxone.
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Affiliation(s)
- Gholamreza Bahoush
- Department of Pediatrics, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; Ali-Asghar Children Hospital.,Ali-Asghar Children Hospital, Tehran, Iran
| | - Marzieh Nojoomi
- Department of Community Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Hutchens TC, Giglio NC, Cilip CM, Rosenbury SG, Hardy LA, Kerr DE, Nau WH, Fried NM. Novel Optical Linear Beam Shaping Designs for use in Laparoscopic Laser Sealing of Vascular Tissues . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5049-5052. [PMID: 33019121 PMCID: PMC8311731 DOI: 10.1109/embc44109.2020.9176571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Suture ligation of vascular tissues is slow and skill intensive. Ultrasonic (US) and radiofrequency (RF) devices enable more rapid vascular tissue ligation to maintain hemostasis, than sutures and mechanical clips, which leave foreign objects in the body and require exchange of instruments. However, US and RF devices are limited by excessive collateral thermal damage to adjacent tissues, and high jaw temperatures that require a long time to cool. A novel alternative method using infrared (IR) laser energy is being developed for more rapid and precise sealing of vessels. This study describes design, modeling, and initial testing of several optical beam shaping geometries for integration into the standard jaws of a laparoscopic device. The objective was to transform the circular laser beam into a linear beam, for uniform, cross-irradiation and sealing of blood vessels. Cylindrical mirrors organized in a staircase geometry provided the best spatial beam profile.Clinical Relevance-This study explored several optical designs for potential integration into the standard jaws of a laparoscopic vessel sealing device, transforming a circular laser beam into a linear beam for sealing of vascular structures.
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8
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Futility of abdominal drain in elective laparoscopic splenectomy. Langenbecks Arch Surg 2020; 405:665-672. [PMID: 32594236 DOI: 10.1007/s00423-020-01915-x] [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: 04/21/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Despite the implementation of minimally invasive surgery and enhanced recovery protocols, the use of drain in elective splenectomy is still controversial. The aim of this study was to assess whether the abdominal drain can impact on short-term outcome after elective laparoscopic splenectomy. METHODS This is a retrospective analysis of a consecutively collected database including all patients who underwent elective laparoscopic splenectomy in our institution between January 2001 and June 2019. Postoperative complications were defined according to a priori criteria and graded according to Clavien-Dindo classification. All complications that occurred during hospitalization or within 30 days after discharge were considered. Primary endpoint was postoperative morbidity, and secondary endpoint was postoperative hospital length of stay. RESULTS One hundred and sixty-one patients were analysed. Intraperitoneal drain was placed in 75 (46.6%) patients. Postoperative complications occurred in 36 (22.4%) patients, while 8 (4.9%) patients had major complications. Median postoperative length of stay was 4 days. At multivariate analysis, only malignancy was significantly associated with the onset of complications (OR 3.50; 95% CI 1.1-11.0; p = 0.032). Malignancy, ASA > 2, conversion to open surgery, presence of drain and longer operation were significantly associated with prolonged length of stay. Patients with drain showed a greater unadjusted risk of abdominal collections (RR 10.32; 95% CI 1.3-79.6; p = 0.006). CONCLUSION Abdominal drain did not reduce morbidity and prolonged the length of stay following elective laparoscopic splenectomy. Therefore, the present study does not support the routine use of drain in such procedure.
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Mesenchymal Stem Cells Combined with Tissue Fusion Technology Promoted Wound Healing in Porcine Bowel Anastomosis. Stem Cells Int 2020; 2020:5142797. [PMID: 32104185 PMCID: PMC7038387 DOI: 10.1155/2020/5142797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the possible biological effect of allogenic mesenchymal stem cells (MSCs) combined with tissue fusion technology on the anastomosis. Methods Sixteen pigs were divided into a 7 d group and 14 d group, each of which was further subdivided into an MSC-treated group and a control group. Five anastomoses per animal were established using LigaSure ForceTriad (Covidien, MA, USA), a tissue sealing system. Cell migration and tissue-specific differentiation potency, in addition to potential cytokine and genetic changes, were investigated. Results There were no significant between-group differences in postoperative complications and anastomosis burst pressure. The number of proliferating cell nuclear antigen- (PCNA-) positive cells was significantly higher in the MSC-treated group as compared with that in the control group (P = 0.021). Labeled MSCs were found in the mucosal layer, villus, and lamina propria, as well as in the lamina muscularis mucosae, where they exhibited characteristics of smooth muscle cells. Conclusions Grafted MSCs significantly promoted epithelial and connective cell proliferation and maintained their cell migration capacity and differentiation potential in the fused anastomotic tissues, without causing severe postoperative complications.
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Fachin CG, Amado F, Romaniello G, Oliveira L, Oliveira I, Wolff L, Granella VH, Tsouristakis AI, Agulham M, Dias AI. Open Versus Laparoscopic Splenectomies in Children: A Comparative Study Performed at a Public Hospital in Brazil. J Laparoendosc Adv Surg Tech A 2019; 29:1357-1361. [DOI: 10.1089/lap.2019.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Camila Girardi Fachin
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Fernando Amado
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Leilane Oliveira
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Igor Oliveira
- Medical School, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Lucas Wolff
- Medical School, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Miguel Agulham
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - André I.B.S. Dias
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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Salama HF, Khirallah MG, Elsawaf MI, ELafify MA. Bipolar sealing devices versus endoscopic vascular staplers during laparoscopic splenectomy in children with benign hematological diseases. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000525978.63934.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hardy LA, Hutchens TC, Larson ER, Gonzalez DA, Chang CH, Nau WH, Fried NM. Rapid sealing of porcine renal blood vessels, ex vivo, using a high power, 1470-nm laser, and laparoscopic prototype. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:58002. [PMID: 28550708 DOI: 10.1117/1.jbo.22.5.058002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
Energy-based, radiofrequency (RF) and ultrasonic (US) devices currently provide rapid sealing of blood vessels during laparoscopic procedures. We are exploring infrared lasers as an alternate energy modality for vessel sealing, capable of generating less collateral thermal damage. Previous studies demonstrated feasibility of sealing vessels in an in vivo porcine model using a 1470-nm laser. However, the initial prototype was designed for testing in open surgery and featured tissue clasping and light delivery mechanisms incompatible with laparoscopic surgery. In this study, a laparoscopic prototype similar to devices currently in surgical use was developed, and performance tests were conducted on porcine renal blood vessels, ex vivo. The 5-mm outer-diameter laparoscopic prototype featured a traditional Maryland jaw configuration that enables tissue manipulation and blunt dissection. Laser energy was delivered through a 550 - ? m -core-diameter optical fiber with side-delivery from the lower jaw and beam dimensions of 18 - mm ? length × 1.2 - mm ? width . The 1470-nm diode laser delivered 68 W with 3-s activation time, consistent with vessel seal times associated with RF and US-based devices. A total of 69 fresh porcine renal vessels with mean diameter of 3.3 ± 1.7 ?? mm were tested, ex vivo. Vessels smaller than 5-mm diameter were consistently sealed (48/51) with burst pressures greater than malignant hypertension blood pressure (180 mmHg), averaging 1038 ± 474 ?? mmHg . Vessels larger than 5 mm were not consistently sealed (6/18), yielding burst pressures of only 174 ± 221 ?? mmHg . Seal width, thermal damage zone, and thermal spread averaged 1.7 ± 0.8 , 3.4 ± 0.7 , and 1.0 ±
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Affiliation(s)
- Luke A Hardy
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Thomas C Hutchens
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | | | - David A Gonzalez
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Chun-Hung Chang
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | | | - Nathaniel M Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
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Ceccanti S, Falconi I, Frediani S, Boscarelli A, Catani M, Cozzi DA. The THUNDERBEAT system for tissue dissection and vascular control in laparoscopic splenectomy. MINIM INVASIV THER 2017; 26:249-252. [PMID: 28145160 DOI: 10.1080/13645706.2017.1281314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The advent of new energy sources for hemostasis has greatly facilitated advanced laparoscopic procedures. We describe a straightforward technique of laparoscopic splenectomy (LS) accomplished using the THUNDERBEAT™ system (TS) (Olympus Medical Systems Corp., Tokyo, Japan) as the sole means of tissue dissection and hemostasis in two patients aged 19 and 6 years, respectively. The specimens were removed intact via a Pfannenstiel incision. Total operative time was 165 and 150 min, and length of hospital stay was three and 4 d, respectively. The TS is an appealing and reliable alternative to currently available energy devices, allowing fast dissection and secure hemostasis during laparoscopic splenectomy.
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Affiliation(s)
- Silvia Ceccanti
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Ilaria Falconi
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Simone Frediani
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Alessandro Boscarelli
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Marco Catani
- b Emergency Department , Policlinico Umberto I, Sapienza University of Rome , Rome , Italy
| | - Denis A Cozzi
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
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Sran H, Sebastian J, Hossain MA. Electrosurgical devices: are we closer to finding the ideal appliance? A critical review of current evidence for the use of electrosurgical devices in general surgery. Expert Rev Med Devices 2016; 13:203-15. [DOI: 10.1586/17434440.2016.1134312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Yazici P, Kaya C, Isil G, Bozkurt E, Mihmanli M. Splenic infarction - A rare cause of acute abdominal pain following gastric surgery: A case series. Int J Surg Case Rep 2015; 10:88-90. [PMID: 25818369 PMCID: PMC4429945 DOI: 10.1016/j.ijscr.2015.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/25/2015] [Accepted: 03/09/2015] [Indexed: 02/07/2023] Open
Abstract
Splenic hilar dissection which is a part of D2 lymphadenectomy has a remarkable role in the curative surgical treatment of gastric cancer. Splenic infarction occurs secondary to any injury to splenic vascular structures and has numerous etiologies. There has been reported no article about splenic infarction following gastric surgery. Incidence of this complication is still unknown. New generation technologies have a major role in surgical area. Particularly, dissection of most regions during surgical resection is performed using vessel sealer device, which is popular in the current surgical era. Postoperative acute abdominal pain radiating to left shoulder following gastric surgery should be considered as a sign of possible splenic complication.
Introduction The dissection of splenic hilar lymph nodes in gastric cancer surgery is indispensable for treating gastric cancers located in the proximal third of the stomach. Splenic vascular injury is a matter of debate resulting on time or delayed splenectomy. We aimed to share our experience and plausible mechanisms causing this complication in two case reports. Case presentations Two male patients with gastric cancer were diagnosed with acute splenic infarction following gastric surgery in the early postoperative period. Both underwent emergent exploratory laparotomy. Splenectomy was performed due to splenic infarction. Discussion Because we observed this rare complication in recent patients whose surgery was performed using vessel-sealing device for splenic hilar dissection, we suggested that extensive mobilization of the surrounding tissues of splenic vascular structures hilum using the vessel sealer could be the reason. Conclusion In case of acute abdominal pain radiating to left shoulder, splenic complications should be taken into consideration in gastric cancer patients performed radical gastrectomy. Meticulous dissection of splenic hilar lymph nodes should be carried out to avoid any splenic vascular injury.
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Affiliation(s)
- Pinar Yazici
- Sisli Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
| | - Cemal Kaya
- Sisli Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - Gurhan Isil
- Sisli Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - Emre Bozkurt
- Sisli Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - Mehmet Mihmanli
- Sisli Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
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Giglio NC, Hutchens TC, Perkins WC, Latimer C, Ward A, Nau WH, Fried NM. Rapid sealing and cutting of porcine blood vessels, ex vivo, using a high-power, 1470-nm diode laser. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:38002. [PMID: 24658792 DOI: 10.1117/1.jbo.19.3.038002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/03/2014] [Indexed: 06/03/2023]
Abstract
Suture ligation with subsequent cutting of blood vessels to maintain hemostasis during surgery is time consuming and skill intensive. Energy-based electrosurgical and ultrasonic devices are often used to replace sutures and mechanical clips to provide rapid hemostasis and decrease surgery time. Some of these devices may create undesirably large collateral zones of thermal damage and tissue necrosis, or require separate mechanical blades for cutting. Infrared lasers are currently being explored as alternative energy sources for vessel sealing applications. In a previous study, a 1470-nm laser was used to seal vessels 1 to 6 mm in diameter in 5 s, yielding burst pressures of ∼500 mmHg. The purpose of this study was to provide vessel sealing times comparable with current energy-based devices, incorporate transection of sealed vessels, and demonstrate high vessel burst pressures to provide a safety margin for future clinical use. A 110-W, 1470-nm laser beam was transmitted through a fiber and beam shaping optics, producing a 90-W linear beam 3.0 by 9.5 mm for sealing (400 W/cm2), and 1.1 by 9.6 mm for cutting (1080 W/cm2). A two-step process sealed and then transected ex vivo porcine renal vessels (1.5 to 8.5 mm diameter) in a bench top setup. Seal and cut times were 1.0 s each. A burst pressure system measured seal strength, and histologic measurements of lateral thermal spread were also recorded. All blood vessels tested (n=55 seal samples) were sealed and cut, with total irradiation times of 2.0 s and mean burst pressures of 1305±783 mmHg. Additional unburst vessels were processed for histological analysis, showing a lateral thermal spread of 0.94±0.48 mm (n=14 seal samples). This study demonstrated that an optical-based system is capable of precisely sealing and cutting a wide range of porcine renal vessel sizes and, with further development, may provide an alternative to radiofrequency- and ultrasonic-based vessel sealing devices.
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Affiliation(s)
- Nicholas C Giglio
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
| | - Thomas C Hutchens
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
| | - William C Perkins
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
| | | | - Arlen Ward
- Covidien, 5920 Longbow Drive, Boulder, Colorado 80301
| | - William H Nau
- Covidien, 5920 Longbow Drive, Boulder, Colorado 80301
| | - Nathaniel M Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
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Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach. Updates Surg 2013; 65:115-9. [PMID: 23355349 DOI: 10.1007/s13304-013-0197-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/11/2013] [Indexed: 12/15/2022]
Abstract
Laparoscopic splenectomy (LS) is nowadays considered as the gold standard for most hematological diseases where splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen lymphoma, a big splenic artery aneurism, or a spleen infarct due to a huge pancreatic pseudo-cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision, hospital stay, and complications were analyzed. We had 14 cases of malignant splenic disease, the most frequent malignant diagnosis was non-Hodgkin's lymphoma (12/14, 85.7 %). Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to laparotomy occurred in two patients (4.16 %), both associated to uncontrollable bleeding in patients with splenomegaly. Mean operative time was 138 ± 22 min. Mean hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-splenectomy infection (OPSI). LS can be performed safely for malignant splenic disease and splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease, splenomegaly, or unusual cases. Massive splenomegaly should be considered as relative contraindication to LS even at experienced centers.
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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.
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Kurt Y, Yücel E, Filiz Aİ, Sücüllü İ, Akin ML. New energy-based devices in laparoscopic splenectomy: Comparison of Ligasure alone versus Ligasure and Ultracision together. SURGICAL PRACTICE 2012. [DOI: 10.1111/j.1744-1633.2011.00577.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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; 9:743-7. [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] [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.
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Affiliation(s)
- Bai Ji
- Department of Hepatobiliary and Pancreatic Surgery, the First Bethune Hospital, Jilin University, Jilin, China
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21
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Siracuse JJ, Saillant NN, Hauser CJ. Technological advancements in the care of the trauma patient. Eur J Trauma Emerg Surg 2011; 38:241-51. [DOI: 10.1007/s00068-011-0160-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 10/15/2011] [Indexed: 12/11/2022]
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Vecchio R, Marchese S, Swehli E, Intagliata E. Splenic hilum management during laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A 2011; 21:717-20. [PMID: 21777061 DOI: 10.1089/lap.2011.0165] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The division of the splenic hilum is the most delicate step during laparoscopic splenectomy. An incorrect approach could lead to a series of related complications. Aim of the study was to report authors' personal experience in a series of 107 laparoscopic splenectomies where the splenic hilum was approached by means of stapling device. A possible relationship between instruments used to divide the splenic artery and vein and complications was analyzed. METHODS Laparoscopic splenectomy was performed in 107 cases at authors' institution between 1998 and January 2011. In all the patients, splenic hilum was approached by means of vascular stapler. RESULTS Indications for the spleen removal mainly were hematologic disorders. Associated surgical procedures were performed in 32 cases. Among the 13 patients who required a conversion to open splenectomy, only in 3 cases the reason was related to the hilum management. Postoperative complications included portal vein thrombosis in 3 cases, pancreatic fistula in 1 case, and bleeding, requiring reintervention, in 2 cases. CONCLUSIONS The use of the stapling device is a safe and effective method to approach the splenic hilum during laparoscopic splenectomy. In experienced hands it showed a low rate of related complications.
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Affiliation(s)
- Rosario Vecchio
- Department of Surgery, Laparoscopic Surgery Unit, University of Catania, Policlinico Vittorio Emanuele Hospital, Catania, Italy.
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Abstract
BACKGROUND Laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases. Bleeding is the main complication and cause for conversion. We present our experience with the LigaSure and discuss its advantage as a vessel sealing system in achieving safe vascular control. METHOD Over a 3-year period, we performed 12 consecutive LS using LigaSure at a single center. A literature review of all the patients who had undergone laparoscopic splenectomy with of the LigaSure to achieve vascular control at the hilum was carried out, assessing its advantages and outcome. RESULTS Twelve LS were performed. Eleven of these patients had ITP, and one patient had sickle cell disease. The mean blood loss was 70mL (range, 50 to 460), and operating time was 126 minutes (range, 110 to 240). Two postoperative complications occurred: portal vein thrombosis in one case and subphrenic collection in the other. The literature review revealed 8 studies with 231 cases in which the LigaSure was used to perform laparoscopic splenectomy. A significant reduction in operating time (average 102 minutes) and intraabdominal blood loss (66mL) was observed with the LigaSure compared with endostaplers. CONCLUSION The use of LigaSure and the semilateral position results in a gain of time and safety in addition to low intraoperative bleeding, need for transfusion, minimal complications and a low conversion rate.
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Gehrig T, Müller-Stich BP, Kenngott H, Fischer L, Mehrabi A, Büchler MW, Gutt CN. LigaSure versus conventional dissection technique in pancreatoduodenectomy: a pilot study. Am J Surg 2011; 201:166-70. [PMID: 20864081 DOI: 10.1016/j.amjsurg.2010.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic surgery requires extensive preparation and tissue dissection. Therefore, LigaSure (Valleylab, Boulder, CO) provides an alternative to conventional dissection techniques. The aim of the present study was to describe the feasibility, safety, and cost efficiency of LigaSure in pancreatoduodenectomy. METHODS Seven patients underwent surgery with the Ligasure and 7 patients underwent surgery with conventional dissection techniques. The patients were investigated for surgical time, intraoperative blood loss, complications, mortality, duration of hospital stay, and surgery-related costs. RESULTS Surgical time was 207 minutes in the LigaSure group and 255 minutes in the conventional group (P = .020). Intraoperative blood loss was 271 and 771 mL, respectively (P = .010). Other perioperative outcomes were comparable. The respective surgery-related costs averaged €4,125 and €4,931 (P = .023). CONCLUSIONS The use of LigaSure in pancreatoduodenectomy seems to be feasible and safe. In addition, it might lead to a reduction in the surgery-related costs.
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Affiliation(s)
- Tobias Gehrig
- Department of General, Abdominal and Transplant Surgery, Ruprecht-Karls-University of Heidelberg, Germany
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25
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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: 1.3] [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.
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Sartori PV, Romano F, Uggeri F, Colombo G, Caprotti R, Giannattasio C, Scotti MA, Delitala A, Prada M, Uggeri F. Energy-based hemostatic devices in laparoscopic adrenalectomy. Langenbecks Arch Surg 2009; 395:111-4. [PMID: 19937340 DOI: 10.1007/s00423-009-0563-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 10/12/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE In literature, few papers compare different hemostatic devices in laparoscopic adrenalectomy. This sequential cohort study analyzes the outcomes of laparoscopic adrenalectomy performed by different hemostatic instruments, to evaluate if any of them has any advantage over the other and as secondary endpoints, the impact of body mass index (BMI) and tumor size on the indication, and the outcome of laparoscopic adrenalectomy. METHODS Forty-six patients, aged 54.6 +/- 46 years, underwent laparoscopic adrenalectomy over 5 years. Mean BMI was 27 +/- 4.8 kg/m(2). Twenty-four patients had a left tumor, and 22 had a right one. Patients were divided into two groups according to the hemostatic device: Ultracision was used in 26 patients, and Ligasure was used in 20. Groups were well matched for histology, tumor size and site, BMI, gender, and age. RESULTS Mean operating time was 126.5 +/- 52 min, blood losses were 101 +/- 169 mm, conversion rate was 6.5%, morbidity was 26%, and hospitalization was 5.3 +/- 2.5 days. Groups did not differ for surgical time, blood losses, complications, and conversion rate; BMI and length of surgery were not related. Tumor side and size did not affect surgical time, regardless of the hemostatic tool. Patients submitted to left adrenalectomy bled more (p = 0.007) and had more complications (p = 0.016) than those undergone operation on the right side. CONCLUSIONS Obesity (BMI > 30) and large masses do not contraindicate laparoscopic adrenalectomy. Left adrenalectomies bleed more and have a higher morbidity. Hemostatic device choice is up to surgeon's preference.
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Affiliation(s)
- Paola Vincenza Sartori
- 1st Surgical Department, S. Gerardo Hospital, University of Milan Bicocca, Via Pergolesi 33, 20052, Monza, Italy.
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Aydogan F, Saribeyoglu K, Simsek O, Salihoglu Z, Carkman S, Salihoglu T, Karatas A, Baca B, Kucuk O, Yavuz N, Pekmezci S. Comparison of the Electrothermal Vessel-Sealing System Versus Endoclip in Laparoscopic Appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19:375-8. [PMID: 19397389 DOI: 10.1089/lap.2008.0368] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Fatih Aydogan
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kaya Saribeyoglu
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Osman Simsek
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ziya Salihoglu
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sinan Carkman
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Tamer Salihoglu
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Adem Karatas
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozan Kucuk
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nihat Yavuz
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Salih Pekmezci
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Bloodless splenectomy during liver transplantation for terminal liver diseases with portal hypertension. J Am Coll Surg 2008; 208:e1-4. [PMID: 19228523 DOI: 10.1016/j.jamcollsurg.2008.10.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 10/23/2008] [Accepted: 10/29/2008] [Indexed: 01/08/2023]
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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.
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Affiliation(s)
- Toru Ikegami
- The Department of Surgery, the University of Tokushima, Tokushima, Japan
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