Video. Radiofrequency fulguration of the spleen under laparoscopy to stop iatrogenic hemorrhage.

BACKGROUND: Iatrogenic splenic injury is a potentially serious complication of laparoscopic surgery associated with significant morbidity and mortality. It also has an impact on the prognosis of patients who undergo surgery for digestive cancer. For iatrogenic splenic injury, splenic salvage is the ultimate goal. Various surgical techniques have been developed to achieve hemostasis of the spleen. Radiofrequency fulguration (RF) is reported to be a safe method in an animal trauma model. However, only three articles report RF for the control of splenic hemorrhage in human patients.
METHODS: A bicentric, retrospective study was performed. From January 2009 to September 2010, all iatrogenic splenic hemorrhages uncontrolled by conventional hemostasis techniques were treated using RF. The splenic injuries were classified according to the Moore classification and a postoperative, abdominal computed tomography scan was performed for each patient. RF was performed with a straight electrode needle (Integra, Tuttlingen, Germany) introduced percutaneously into the spleen. The electrode was infused with isotonic saline and connected to a 500-kHz generator (Elektrotom 106 HFTT; Berchtold, Tuttlingen, Germany). During the high-frequency coagulation (375 kHz), electrode saline perfusion was automatically regulated from 30 to 110 ml/h according to the variation in tissue impedance, and the power of the generator was kept at 50 W.
RESULTS: Three patients (2 men and 1 woman) with a median age of 58 years underwent splenic RF. The splenic injuries (grade 3, Moore classification) occurred during laparoscopic proctectomy in two cases and during laparoscopic gastrectomy in one case. It was possible to achieve complete hemostasis in all the patients during a median time of 10 min. The median blood loss was 100 ml, with no blood transfusion. No splenectomy was necessary, and no postoperative splenic infarction was diagnosed. No conversion was performed. There was no postoperative morbidity or mortality. No recurrent splenic hemorrhage occurred during the follow-up period. The financial cost was 350<euro> per RF.
CONCLUSION: Although RF could potentially induce splenic infarction in the event of a large-scale fulguration, it is a safe, quick, and effective spleen-preserving technique for stopping an iatrogenic splenic hemorrhage when conventional hemostasis techniques fail. Furthermore, it is readily available and easy to set up in an emergency situation and can be performed easily by laparoscopy without an additional port.