Search

This report describes the use of laparoscopic accessory splenectomy in treating recurrent idiopathic thrombocytopenic purpura (ITP). The patient presented 36 months after initial splenectomy with a platelet count of 16,000 cells/microl and nontolerance of medical therapy. A technetium-99 labeled, heat-damaged red blood cell scan revealed two small foci in the upper left quadrant. This finding was confirmed by an abdominal computed tomography scan. After laparoscopic accessory splenectomy, the patient was discharged (23 h after surgery) and at 9 months showed a platelet count of 234,000 cells/microl with no medical therapy. A minimally invasive approach to accessory spleen removal can be beneficial to patients with recurrent ITP and documented accessory splenic tissue.

Ultrasonic energy has not been previously used for surgical cutting and coagulating. Work in our laboratory has led to the development of an ultrasonically activated scalpel that safely and effectively cuts and coagulates tissue in animals. The purpose of this study was to determine if ultrasonic energy can replace monopolar electrosurgery in human laparoscopic surgery. Two hundred consecutive patients underwent laparoscopic cholecystectomy with the ultrasonically activated scalpel. The scalpel was the sole energy form in 98 of the first 100 patients, and in all of the last 100 patients. There were no common duct injuries, reoperations, or mortality. No patient had more than a 3-g drop in hemoglobin or transfusion. The ultrasonically activated scalpel is a safe and effective energy form for cutting and coagulating tissue during laparoscopic cholecystectomy in humans. The absence of need of monopolar electrosurgery combined with hemostatic effectiveness supports the concept that the ultrasonically activated scalpel can replace electrosurgery for laparoscopic cholecystectomy.

We have developed an ultrasonic scalpel for laparoscopic use using the porcine cholecystectomy model. Based on experimentation with various blades, the hook-spatula blade appears to offer the best mix of coagulation and cutting. The advantages of this device are that it does not make smoke, causes minimal tissue injury, is safe to the surgeon and patient, and facilitates dissection. We believe it has the potential to become the preferred energy form for therapeutic laparoscopic surgery.

Congenital absence of the gallbladder is an extremely rare anomaly. Although ideally gallbladder agenesis should be diagnosed before surgery, this has not been documented in the literature. Laparoscopy offers patients with nonvisualizing or shrunken gallbladders on imaging studies the opportunity for diagnosis in a minimally invasive manner. A thorough laparoscopic exploration and cholangiogram are necessary to confirm the diagnosis.