A blunt dissection technique using the LigaSure vessel-sealing device improves perioperative outcomes and postoperative splenic-vessel patency after laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy

Abstract

Background: We have recently performed a blunt dissection technique using LigaSure technology for laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy to reduce the risk of bleeding during the dissection of the splenic vessels. The aim of this study was to compare the utility of the blunt dissection technique and a conventional dissection technique during laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy.

Methods: Fifty-five patients who underwent laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy performed by a single surgeon between March 2003 and December 2015 were enrolled in this retrospective single-center study. The patients were divided into the LigaSure group (n = 23) and non-LigaSure group (n = 26). Perioperative clinical outcomes and the postoperative patency of the preserved splenic vessels in the two groups were compared.

Results: The patient and tumor characteristics did not differ significantly between the two groups. The incidence of postoperative complications was similar in the two groups. However, the mean operative time (145 vs. 231.1 min, P = 0.001), intraoperative blood loss (95.6 vs. 360 ml, P = 0.001), and postoperative hospital stay (6.4 vs. 9.8 days, P = 0.001) were significantly lower in the LigaSure group than in the non-LigaSure group, respectively. The splenic artery patency rate was similar in both groups, but the splenic vein patency was significantly better in the LigaSure group than in the non-LigaSure group (total occlusion rate: 4.5 vs. 30.8%, respectively, P = 0.017).

Conclusion: The results of this study suggest that the blunt dissection technique using a LigaSure reduces the operating time and intraoperative blood loss during laparoscopic spleen- and splenic-vessel-preserving distal pancreatectomy and increases the patency of the preserved splenic vessels.

Keywords: Distal pancreatectomy; Laparoscopy; LigaSure; Splenic-vessel preservation.