New Technique for Splenectomies

Splenectomies are traditionally performed by ligation of either individual hilar vessels or major splenic vessels; either technique can be very time-consuming. The use of different clamping or ligation methods, such as hemostatic clips, may reduce surgical times. Hemostatic clips have several drawbacks (clip instability, limited use in vessels <_ to 4 mm in diameter, and implantation of nonabsorbable materials). Surgical techniques require careful attention to avoid dislodging a clip. The vessel sealant device (Ligasure, covidien.com) described in this article is an electrothermal bipolar sealing system that achieves local hemostasis by bipolar energy-emitted vessel compression and obliteration. The heat generated by jaw compression induces collagen and elastin fusion in vessel walls and subsequent tissue reformation with creation of a permanent seal zone; a proximal thrombus also contributes to vessel occlusion. The device employs several measures to avoid thermal injury to surrounding tissues. This article describes the use of a vessel sealant device in 27 dogs with naturally occurring splenic disease. Splenectomy was performed successfully in each dog and no device failures occurred during surgery. No dogs required suture ligation of the vessels, and blood loss was not recorded during vessel sealing. A single dog was readmitted 4 days postoperatively due to a hemoabdomen that likely resulted from sealing the splenic artery and vein too close to the pancreatic branch, causing pancreatitis and bleeding.

Commentary: This technology is uncommon in general practice, which is a disadvantage because use of the device would require education. It was also unclear how frequently the device can be used (reusable versus disposable) and what its overall expense is compared with ligatures or clips. However, this article demonstrates that in a small population of dogs with naturally occurring disease, the vessel sealant device provided adequate hemostasis, was a technically easy procedure, required minimal to no surgical dissection preapplication, and resulted in no remaining foreign material in the abdomen.—Heather Troyer, DVM, Diplomate ABVP (Canine & Feline Practice)

Use of a vessel sealant device for splenectomy in dogs. Rivier P, Monnet E. VET SURG 40:102-105, 2011.