Effectiveness of Articulating Linear Stapler for Total and Partial Laparoscopic Splenectomy in Children.

Purpose: We performed a retrospective study to determine the effectiveness and feasibility of articulating linear stapler in laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS), focusing on technical laparoscopic skills that could help pediatric surgeons to avoid intra- and postoperative complications. Methods: Retrospective cohort study of children younger than 18 years who underwent laparoscopic spleen surgery between January 2008 and March 2020. Age, sex, indication for surgery, operative time (OT), intra- and postoperative complications, and postoperative length of hospital stay (LHS) were analyzed. Data from parenchymal resection and vessels sealing techniques were obtained. Results: Thirty patients, 19 LTS and 11 LPS, were included. The mean age of the patients was 10.9 years, and 16 patients were male and 14 were female. For hematologic diseases, LTS was the elective surgery, associated with cholecystectomy in 5 cases. LPS was the common procedure for splenic cysts. The stapler was used in LTS to close the hilum vessels and in LPS for parenchymal resection. No statistically significant differences in OT were observed comparing LTS and LPS. Two conversions occurred in LTS; none in LPS. The mean LHS was 6 days in both groups. No recurrence or major complications appeared in both groups at 1-12 years of follow-up. In particular for LPS, there are no relapse of cyst neither reduction in splenic function. Conclusions: This study shows the effectiveness, feasibility, and safety of mechanic stapler in splenic surgery both for hilum vessels sealing and for parenchymal resection. The use of this device can reduce risk of hemorrhagic recurrences or major surgical complications improving the safety of the operation.

Use of a Bipolar Vessel-Sealing Device for Splenic Parenchymal Resection in Three Dogs and One Cat.

Based on splenic abnormalities noted during surgery, four client-owned animals (three dogs, one cat) undergoing exploratory laparotomy were identified as candidates for partial splenectomy. In three cases, small mass lesions of the spleen were identified on elective exploratory laparotomy. In one case, the patient was referred for emergency surgery for diaphragmatic hernia with entrapment of stomach and spleen. The discovery of avulsion of a significant portion of the splenic mesentery led to the decision to perform partial splenectomy in this case. All animals included in the study underwent partial splenectomy by one of two board-certified veterinary surgeons at a multispecialty hospital between 2014 and 2018. The same type of bipolar vessel-sealing device was used in each surgery, and three of four partial splenectomy cases recovered uneventfully. One patient went into cardiopulmonary arrest hours after surgery and died; however, this is not suspected to be due to the described partial splenectomy technique. The bipolar vessel-sealing device is suitable for use in resection of the splenic parenchyma in some canine and feline patients. This technique is designed to decrease surgical time, provide effective hemostasis, and preserve the important functions of the spleen that are lost when total splenectomy is undertaken.

A Novel Non-Gas Endospray for Applying Fibrin Glue in Laparoscopic Surgery.

Purpose: Fibrin glue and polyglycolic acid felt are used for tissue repair in various surgical procedures. However, using a spray device to apply fibrin sealant during laparoscopic surgery can increase the intraperitoneal pressure, which can cause complications such as air embolism. We developed a novel non-gas endospray for use in laparoscopic surgery. This study aimed to evaluate the sealing effect of this non-gas endospray in comparison with a conventional gas-spray device and to evaluate the safety of its application in the clinical setting. Materials and Methods: An ex vivo pressure test model was used to assess the sealing effect of the non-gas endospray (method 1) versus conventional gas-spray (method 2). A bottle was sealed with a rabbit skin sample that had been pierced nine times by a 19G needle. Each skin sample was sealed using either method 1 or method 2 (n = 10 for each method). The non-gas endospray was then used in two patients undergoing laparoscopic splenectomy with CO2 pneumoperitoneum. Intra-abdominal pressure was measured throughout the surgery. Results: Bursting pressures were similar in method 1 (246.9 ± 123.2 mmHg) and method 2 (265.5 ± 93.6 mmHg; P = 0.7082). During laparoscopic splenectomy, the non-gas endospray was successfully used to apply fibrin glue without any increase in intra-abdominal pressure. Conclusions: The novel non-gas endospray produced a strong sealing effect similar to that of a conventional gas-spray device and has thus far proved feasible in the clinical setting.

Technological Advances in Surgical Equipment in Exotic Pet Medicine.

Surgery can be challenging in exotic pets owing to their small size and blood volume, and their increased anesthetic risk compared with small animals. Various devices are available to facilitate suturing, cutting, and hemostasis in the human and veterinary fields. These surgical equipment improve the simplicity, rapidity, and effectiveness of surgery. Vessel-sealing devices, radiosurgery, lasers, and ultrasound devices are commonly used because of their ease of use and increase in surgical efficiency. Other surgical devices are available (eg, stapling devices) but are not discussed in this article.

Endoscopic linear stapler-assisted resection of a giant solid pseudopapillary pancreatic tumor with concurrent regional portal hypertension: a case report.

Solid pseudopapillary tumor of the pancreas (SPTP) is a rare neoplasm with a low incidence and low rate of malignancy. We herein report a rare case of SPTP concurrent with regional portal hypertension (RPH) that was successfully treated by distal pancreatectomy and splenectomy. A 22-year-old woman presented with a left upper abdominal apophysis and normal liver function. She was diagnosed with an SPTP and RPH by abdominal ultrasound and computed tomography, and she subsequently underwent distal pancreatectomy and splenectomy. Noticeably, varicose vein plexus with wide range appeared on the upper edge of the pancreatic body and posterior gastric wall of the patient. Therefore, we created a path to avoid touching the varicose veins and took advantage of the endoscopic linear stapler to staple the veins. We herein report our surgical experience on SPTP assisted with the endoscopic linear stapler, which will be very realistic for the management of this rare clinical entity.

Is the bipolar vessel sealer device an effective tool in robotic surgery? A retrospective analysis of our experience and a meta-analysis of the literature about different robotic procedures by investigating operative data and post-operative course.

BACKGROUND: The latest robotic bipolar vessel sealing tools have been described to be effective allowing to perform procedures with reduced blood loss and shorter operative times. The aim of this study was to assess the efficacy and reliability of these devices applied in different robotic procedures. MATERIAL AND METHODS: All robotic operations, between 2014 and 2016, were performed using the EndoWrist One VesselSealer (EWO, Intuitive Surgical, Sunnyvale, CA), a bipolar fully wristed device. Data, including age, gender, body mass index (BMI), were collected. Robot docking time, intraoperative blood loss, robot malfunctioning and overall operative time were analyzed. A meta-analysis of the literature was carried out to point the attention to three different parameters (mean blood loss, operating time and hospital stay) trying to identify how different coagulation devices may affect them. RESULTS: In 73 robotic procedures, the mean operative time was 118.2 minutes (75-125 minutes). Mean hospital stay was four days (2-10 days). There were two post-operative complications (2.74%). CONCLUSIONS: The bipolar vessel sealer offers the efficacy of bipolar diathermy and the advantages of a fully wristed instrument. It does not require any change of instruments for coagulation or involvement of the bedside assistant surgeon. These characteristics lead to a reduction in operative time.

The THUNDERBEAT system for tissue dissection and vascular control in laparoscopic splenectomy.

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.

Partial splenectomy using a laparoscopic bipolar radiofrequency device: a case report.

We report a 51-year-old female patient with a solitary lymphangioma located in the upper splenic pole which was managed successfully with laparoscopic partial splenectomy. Surgery lasted 170 min and did not require blood transfusions. The patient recovered well post-operatively and was asymptomatic at the 3-mo follow-up. She had a normal platelet count and no recurrence on ultrasonography or computed tomography. Laparoscopic partial splenectomy is a safe, minimally invasive technique for the treatment of solitary splenic lymphangiomas in the splenic pole. We performed the procedure using the Habib(TM) 4X device. This laparoscopic bipolar radiofrequency device ensured a "bloodless" splenic parenchymal resection.

[Efficacy of splenectomy plus selective pericardial devascularization under endoscope in treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism].

OBJECTIVE: To evaluate the efficacy of splenectomy plus selective pericardial devascularization under endoscope in the treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism so as to explore the minimally invasive and safer surgical treatment. METHODS: A secure splenectomy was performed with laparoscope and its supporting devices, and at the same time, the ligation of the left gastric vein and the ligation of esophageal vein perforating vertically into the esophagus were also performed in 14 advanced schistosomiasis patients with portal hypertension and hypersplenism. RESULTS: Among the 14 patients, the splenic artery was separated and clipped before the treatment of splenic pedicle. One patient was of conversion to open laparotomy for the splenic vein rupture bleeding in the separation. There was no death. CONCLUSION: The operation of splenectomy plus selective pericardial devascularization under endoscope is effective, truly minimally invasive, and safe in the treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism.

Reusable single-port access device shortens operative time and reduces operative costs.

BACKGROUND: In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy. METHODS: We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student's t test was used for statistical analysis. RESULTS: SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40-116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p < 0.001). Prices of disposable SPL instruments and multiport access devices as well as extraction bags from different manufacturers were used to calculate the cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy. CONCLUSION: Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.

Transumbilical single-incision endoscopic splenectomy: report of ten cases.

AIM: To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments. METHODS: Between 2010 and 2012, transumbilical single-incision endoscopic splenectomy was performed in 10 patients in our department, of whom 4 had refractory idiopathic thrombocytopenic purpura, 4 had enlarged splenic cyst and 2 had splenic hematoma. A 2.5-cm curved incision was made at the lower umbilicus edge, and a 10 mm laparoscope was inserted into the middle of the incision. A 5-mm harmonic scalpel was placed on the right side, and a 5-mm auxiliary instrument on the left side of the laparoscope. Splenic ligaments were incised with a harmonic scalpel, and the splenic pedicle was cut with an Endo-gastrointestinal anastomosis. The spleen was dissected and placed in a large retrieval bag, blended, and then removed. RESULTS: All transumbilical single-incision endoscopic splenectomies were performed successfully with mean operative time of 80 ± 5 min and mean blood loss of 150 ± 20 mL. Conversion to laparotomy or multi-port laparoscopic surgery was not required in all cases. All patients were discharged on postoperative days 4-6. During the postoperative hospitalization period, no painkillers were required. No intra-abdominal complications such as infection, ascites, gastric leakage, pancreatic leakage, or wound infection occurred in any case during the 6-mo follow-up. CONCLUSION: Transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments is technically feasible and safe in selected patients.

Linfoma primario de bazo. Presentación de un caso / Primary lymphoma of the spleen. Case presentation

Fundamento: en el bazo se pueden observar diferentes tipos de tumores, dentro de los cuales están los linfomas primarios del mismo, enfermedad infrecuente, de ahí la importancia de su presentación. Presentación de caso: paciente femenina de 66 años, raza blanca, con antecedentes de hipertensión arterial, lobectomía derecha del tiroides, que refiere venía presentando desde hacía más de un año dolor abdominal alto izquierdo que se hacía más intenso tras el esfuerzo físico, tos, presentando toma del estado general por lo que se ingresa en el servicio de cirugía. Se toman muestras para biopsia, después de ser intervenido quirúrgicamente de una esplenectomía, dando como resultado un Linfoma no Hodgkin de células grandes CD20 positivo, sin infiltración hepática, ganglionar ni epiplóica. Se realizó esplenectomía y quimioterapia. La paciente ha evolucionado favorablemente. Conclusiones: el linfoma primario de bazo es una entidad infrecuente y su diagnóstico es aún más raro en pacientes por encima de los 60 años, como ocurrió en el caso presentado. A medida que casos como este se divulguen entre los profesionales de la salud permitirán una aproximación diagnóstica más precisa a esta enfermedad poco común.

Background: in the spleen you can see different types of tumors; primary lymphomas are an example of them. This is an infrequent disease, hence the importance of its presentation. Case presentation: 66 year old white female patient with history of hypertension, thyroid right lobectomy that refers to have been suffering from high left abdominal pain for a year that became more intense after physical exertion, cough, presenting general malaise by what is admitted to the surgical service. Some samples for biopsy are taken, after being surgically operated of a splenectomy, showing as a result a non-Hodkin lymphoma of big cells resulting cell non-Hodgkin lymphoma CD20 Positive, without hepatic, ganglionic or epiploic infiltration. Splenectomy and chemotherapy were made. The patient has improved favorably. Conclusions: primary lymphoma of the spleen is a rare entity and its diagnosis is still rarer in patients over 60 years, as it happened in the case presented. As cases like these are disseminated among health professionals will allow a more accurate diagnostic approach to this rare disease.

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

Laparoscopic splenectomy (LS) has been accepted as a safe and effective procedure as compared with open splenectomy. Recently, there have been a few reports on the LigaSure vessel sealing system as an alternative hemostasis to clip ligation. Here we report the experience of LS using an alternative energy device, Harmonic Scalpel laparoscopic coagulating shears (LCS). Preliminary experience of LS with LCS for a patient with idiopathic thrombocytopenic purpura (ITP) is reported. Generally, two-step sealing with LCS was used for vessels of the splenic pedicle approximately 5 mm in diameter without using the Endo-GIA stapler. Operative time was 93 minutes, and blood loss was 40 mL. The patient was discharged on the third postoperative day with no intraoperative or postoperative complications. The LS with LCS was performed safely using two-step sealing. Further experience is necessary to verify the safety of this procedure.

Stapleless laparoscopic splenectomy with individual vessel dissection in patients with splenomegaly.

BACKGROUND: Mechanical stapling devices have been established as a mainstay in laparoscopic splenectomy (LS), but limited data are available regarding stapleless LS for splenomegaly with individual vessel dissection (IVD). This study aimed to investigate the feasibility of stapleless LS for splenomegaly and its potential advantage over staple-based LS. METHODS: A total of 51 patients with splenomegaly underwent stapleless LS and were subsequently reviewed. The data collected include the patients' demographics, operative outcomes, and the rates of conversion to open surgery, complications, and mortality. Multiple linear and logistic regression analyses were used to assess the impact of the primary diagnosis, body mass index (BMI), and massive splenomegaly on the perioperative conversion rate. RESULTS: There were no deaths. The mean for various parameters are as follows: spleen length 21.6 cm; spleen weight 1,184 g, operating time 148 min, hospital stay 5.2 days, estimated blood loss 245 ml. The total conversion rate was 9.8 % (including one reoperation for bleeding). The presence of a BMI >30 % and hematologic malignancy-cofactors of portal hypertension (PH)-and a spleen weight >1,000 g were independent predictors of conversion to open surgery. CONCLUSIONS: Stapleless LS for splenomegaly is feasible and safe in selected patients. It has advantages over traditional procedures using staples, at least in patients with benign splenomegaly. Patients with hematologic malignancy, BMI >30 %, coexistence of PH, and spleen weight >1,000 g are susceptible to bleeding during dissection of the splenic hilum, with use of IVD being relatively limited.

Laparoscopic radiofrequency ablation for traumatic splenic rupture.

BACKGROUND: Laparotomy was formerly the routine approach for treating traumatic splenic rupture. Traumatic splenic rupture has traditionally been treated with open splenectomy. The advent of laparoscopy and radiofrequency ablation (RFA) has ushered in new approaches to this surgical problem. The purpose of this study was to evaluate the use of laparoscopic RFA to treat traumatic splenic rupture. METHODS: Four patients with traumatic splenic ruptures underwent laparoscopic RFA-assisted spleen-preserving surgery between September 2011 and April 2012. RFA electrodes were used for traumatic rupture repair or partial splenectomies using classic laparoscopic procedures. Safety and efficacy parameters were documented, including surgery time, intraoperative blood loss, postoperative drainage quantities, and recovery conditions. RESULTS: Three patients received laparoscopic splenic rupture repair and one patient received a partial splenectomy. Three surgeries were successful, based on 1-mo follow-up with computerized tomography and ultrasound examinations that indicated the restoration of satisfactory splenic blood supply. The fourth patient received a laparotomy for a total splenectomy because of massive postoperative bleeding 24 h after surgery. CONCLUSIONS: Laparoscopic RFA-assisted spleen-preserving surgery is another modality that may be considered in the management of splenic trauma. This small sample size and limited clinical experience does not justify its use on a routine basis and requires additional clinical research to fully evaluate its efficacy in certain critical traumatic scenarios compared with traditional open splenectomy.

[Investigation on the impact of hot temperature methods of the tissue dissection and coagulation on parenchymatous organs in experiment].

There are adduced the results of experimental operations on mongrel rabbits with dissection and coagulation of the liver and the spleen, using highly temperature coagulation apparatuses of various kinds. There was established, that while application of various highly temperature technologies a typical process occurs, consisting of the heat spreading inside the organ. The temperature raising grade depends on the method and duration of the impact.

Single-incision laparoscopic splenectomy: preliminary experience in consecutive patients and comparison to standard laparoscopic splenectomy.

BACKGROUND: Since first being described in 2009, single-incision laparoscopic splenectomy has been described in a limited number of case reports and small case series. No studies have evaluated single-incision splenectomy in unselected patients, and outcomes of the procedure have not previously been compared to standard laparoscopy. METHODS: A retrospective review was conducted to evaluate all single-incision splenectomies performed by a single surgeon between June 2010 and June 2011. Additionally, patients who underwent standard laparoscopic splenectomy by surgeons in the same tertiary referral surgical oncology group were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed. RESULTS: Eight patients underwent successful single-incision splenectomy during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 92.5 min. There was 25 % morbidity and no mortality in the study group. Median length of stay was 4 days. Additionally, 18 patients who underwent standard laparoscopic splenectomy were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. Single-incision splenectomy was associated with a shorter operative time (92.5 vs. 172 min, p = 0.003), lower conversion rate, equivalent length of stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements. CONCLUSIONS: Single-incision splenectomy is feasible, safe, and efficient in an unselected patient population in the hands of an experienced laparoscopic surgeon. The single-incision technique is comparable to standard laparoscopic splenectomy in terms of operative time and perioperative outcomes.

[Experimental investigation of possibilities of the ultrasound and liquid-stream dissector in operations on parenchymatous organs].

The results of experimental investigations were adduced, concerning studying of possibilities and the outcomes analysis of the ultrasound and a liquid-stream dissector application while operating on parenchymatous organs. There was established, that while operating on liver, there was not any essential difference between application of the ultrasound and stream of a liquid concerning the achievement of a quality of the stroma elements isolation; while performing operations on the spleen a liquid-stream dissector have had evolved as a more effective one, permitting to isolate a significantly more quantity of unaffected elements of stroma. The hemostasis methods are the main, which influence the organs stump formation and the typical cellular structure restoration, and they must be applied, using the both methods of dissection.

Partial pancreatectomy and splenectomy using a bipolar vessel sealing device in a cat with an anaplastic pancreatic carcinoma.

A 14-year old domestic shorthair cat was presented because of vomiting, anorexia and an abdominal mass. A diagnosis could not be made preoperative and during surgery the mass was assigned to the gastric part of the pancreas. A partial pancreatectomy and splenectomy was performed using a Ligasure® vessel sealing device. No surgery related complications occurred. Histological examination revealed an anaplastic carcinoma of the pancreas. The cat was in a good clinical condition 14 days after surgery. After 2 months the cat was euthanized with the suspicion of a bone tumor. Findings of this case demonstrate that pancreatic carcinoma in cats has a poor prognosis but pancreatectomy can be performed using a bipolar vessel sealing device as a safe and fast alternative to standard surgical techniques.