الفهرس 
ANATOMY OF THE SPLEENOnly 14 pages are availabe for public view
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Abstract
With increasing experience in laparoscopic surgical techniques, LS has
become the gold standard method for treatment of spleen hematological
diseases.
Deletaire originally described laparoscopic splenectomy, in 1991.Since
then, numerous case reports, case series and comparative studies have
repeatedly demonstrated the safety (mortality rates <1%) and efficacy of thistechnique. Indeed, it is now considered standard of care for most electivenormal size spleens with hematological disorders.
Bleeding is the most common cause of open conversion. Bleeding
usually occurs because of hilar vessels or capsular injury during dissection of
the splenic hilum. Dissection of the splenic hilum is usually needed when
endo-GIA stapler is used; hence, the risk of bleeding is higher in this group.In several studies, ligasure has been used to secure hemostasis of the
splenic hilum in LS. Because there is no need for dissection of the splenic
hilum and hemostasis is well established in the ligasure method.
This study aims to compare two techniques of LS, one based on the
use of ultrasonically -activated devices with Endo staplers (Group I) and the
other on the use of Ligasure TM Vessel Sealing System (Vallylab, Boulder,
Co, USA) (Group II).
In our study, 40 patients with spleen hematological disorders were
underwent laparoscopic splenectomy, however operation was completed
successfully in 35 patients, conversion to open splenectomy was done in 5
patients due to hilar bleeding.
Summary Operation time, intraoperative blood loss and the cost of operation
are less in stapleless laparoscopic spleenectomy using LVSS in
comparison with stapled technique.
Searching for accessory spleens is an important step since missing
accessory spleens is the major cause of failure of LS in ITP.
We could conclude that both the stapled- LS and Stapleless-LS
techniques were successful in achieving laparoscopic Splenectomy. Yet,
Ligasure TM has the advantage of saving time, as it obviates the need for
instrument interchange as well as being more economic and less
intraoperative blood loss. It may prove safer as it does not require
hazardous meticulous dissection of the splenic hilum.