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.