Use of 10 mm LigaSure Atlas during laparoscopic splenectomy for splenic abscess

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Use of 10 mm LigaSure Atlas during laparoscopic splenectomy for splenic abscess

Authors

J Leroy, J Marescaux

Keywords

splénectomie,LigaSure

Media type

Surgical video

Duration

07'27''

Publication

2004-12

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E-publication

WeBSurg.com, Dec 2004;4(12).
URL: http://www.websurg.com/doi-vd01en1614.htm

Use of 10 mm LigaSure Atlas during laparoscopic splenectomy for splenic abscess

1. Trocar placement 00'08''

This video will demonstrate laparoscopic splenectomy for a splenic abscess using the 10mm Ligasure Atlas. This is the CT-scan of the patient showing the position of the splenic abscess. Four trocars are used as shown and the patient is placed in a supine position for an anterior approach to the spleen.

2. Exposure 00'34''

There is an adhesion to the abdominal wall, which needs to be divided to improve the operative field. This is done rapidly with the Ligasure, which gives a secure hemostatic effect. The patient developed a splenic abscess in the inferior pole of the spleen secondary to an infected mechanical heart valve. The local inflammation has led to the formation of these adhesions, which seem to attach the spleen firmly to the surrounding tissues. An anterior approach is preferred in order to avoid dissecting the diaphragmatic adhesions for a more conventional posterior approach. The Ligasure is a sealing device, which is able to apply a consistent hemostatic coagulation effect through feedback. Thus, the surgeon is reassured that the vessels are coagulated prior to cutting.

3. Dissection 02'01''

The dissection is continued gradually from inferior to superior in order to isolate the splenic vessels. Some bleeding is expected in this inflammatory tissue. Now the dissection is continued in the area of the splenic hilum. The Ligasure can securely coagulate the splenic vessels. We can see the abscess coming into view as the dissection is continued. Now to the posterior aspect of the spleen. As you can see, the Ligasure can also be used as a tool for blunt dissection a bit like a finger. We continue in the posterior plane with the combination of suction, counter-traction, and the Ligasure. Care is taken not to perforate the diaphragm at this point. The posterior aspect is now almost completely free. The final attachment is divided. And then, we can move on to the medial aspect after this.

4. Division of main splenic vessels 04'41''

We divide the short gastric vessels as well as the main splenic vessels using the Ligasure device. Finally, we detach the spleen superiorly in order to completely free the organ. A washout is performed and there seems to be no active bleeding.

5. Extraction 05'42''

In order to retrieve the spleen, a bag is introduced from the port as shown. The bag is opened intracorporeally. The spleen is then placed in the bag in preparation for retrieval. Once the bag is closed, a string is pulled. And the trocar site needs to be extended in order to accommodate for the size of the organ. A wound protector is applied in order to protect the wound from infection. And the bag is then brought extracorporeally. And the spleen is fractured using this rigid device, and then removed from the body by piecemeal. This of course helps to have a smaller incision for retrieval. Another washout and a check for hemostasis and a drain is placed in the empty splenic bed and this is the end of the operation.