Single-incision laparoscopic hepatectomy: a case report

Single incision laparoscopic hepatectomy: A systematic review

Single incision laparoscopic surgery is a rather innovative surgical technique. A systematic literature review was performed with the intention to evaluate the till now clinical evidence regarding the application of single incision technique on liver resections as a method of management in hepatic lesions. Twelve relative studies were found in the field including 30 patients with a age range from 29 to 90 years and a body mass index from 20.1 to 36.5 kg/m². Primary hepatic carcinoma (40%), metastatic nodules (26.7%), hepatic cysts (16.7%), hepatic haemangiomas (13.3%) and hepatic adenoma (3.3%) were the most common indications of the lesions resected. The types of hepatectomy performed included partial hepatectomy (43.3%), segmentectomy (30%) and lobectomy (26.7%). In the majority of the patients, left lateral segments (II-III-IV) (76.7%) were resected. The median operative time was 110 min (range: 55-235) while the median quantity of blood loss was 50 ml (range: 0-100). No conversion to open surgery and no transfusion were needed. The duration of hospital stay ranged between 2 and 11 days. No complications, no cases of disease recurrence or death of patients were reported. None of the studies included described data on the cosmesis of the application of single incision laparoscopic technique on hepatic resections. Moreover, the surgical technique, as well as the different type of ports used is also presented in this review. Single site port laparoscopic surgery is a promising minimally invasive procedure for liver resections.

Single-incision laparoscopic surgery for giant hepatic cyst

INTRODUCTION

The aim of this study was to assess the feasibility and safety of single-incision laparoscopic fenestration and to introduce a new surgical technique. Laparoscopic fenestration has become a standard approach for symptomatic hepatic cysts because of the low recurrence rate and minimal postoperative pain. The single-incision laparoscopic surgery (SILS) technique has increasingly gained acceptance and is now applied to a variety of organs and operations.

MATERIALS AND SURGICAL TECHNIQUE

Between February 2010 and March 2011, we consecutively performed six cases of single-incision laparoscopic fenestration. A SILS Port was placed through a single intraumbilical skin incision. In addition to standard laparoscopic instruments, a flexible 5-mm laparoscope and an articulating grasper were used. The cyst wall was dissected with a 5-mm bipolar vessel sealer. SILS was successfully performed in all patients, and none required conversion to conventional multiport laparoscopic surgery or open surgery. Intraoperative blood loss was minimal in all cases. Median operative time was 144 min (range, 100-210 min). All patients were discharged uneventfully on 3 day postoperative. Median postoperative follow-up at 15.5 months (range, 8-20 months) did not reveal any complications or recurrence. The umbilical incisions were almost unnoticeable.

DISCUSSION

Our findings suggest that SILS for fenestration of a giant hepatic cyst is a safe and feasible. It is reproducible technique that is comparable to conventional laparoscopic surgery.

Adopting Gayet's Techniques of Totally Laparoscopic Liver Surgery in the United States

Professor Brice Gayet of the Institut Mutualiste Montsouris in Paris, France, has developed totally laparoscopic techniques for all segments of the liver. As a pioneer in the field of minimally invasive hepato-pancreato-biliary surgery, he started a Minimally Invasive Hepato-Pancreato-Biliary Fellowship in 2006. A retrospective review of all hepatic cases performed by a single surgeon since completing this Fellowship was undertaken. From November 2007 to October 2012, a total of 80 liver resections were done, of which 73 were begun with the intention of completing the case laparoscopically. Of these, more than 90% were completed laparoscopically and 88% were for malignant disease. One of the foundations of Professor Gayet's techniques is the low lithotomy or 'French' position and the utilization of a small robotically controlled laparoscope holder that is sterilizeable and considerably more economic than complete surgical systems. Prototypes exist of robotically controlled hand-held laparoscopic instruments that, unlike the complete surgical system, enable surgeons to maintain a sense of touch (haptics). Proper training in minimally invasive hepato-pancreato-biliary techniques can be obtained with surgeons able to independently perform laparoscopic major hepatectomies without senior minimally invasive backup. Furthermore, miniature and more affordable robotics may enable more surgeons to enjoy the benefits of minimally invasive surgery while maintaining patient safety and minimizing the rising burden of health-care costs worldwide.