Single incision transumbilical laparoscopic left hepatic lobectomy

Background: Single-incision laparoscopy (SIL) recently gained interest mainly to improve the cosmetic outcomes. This video shows a patient submitted to left hepatic lobectomy by transumbilical SIL. Video: A 24 year-old woman with a BMI of 24.4 kg/m2 consulted for a hydatid cyst of the II-III hepatic segments. Preoperative work-up showed a hepatic hydatid cyst of the segment III, partially involving the segment II. A transumbilical SIL was performed using an 11mm trocar for a 10mm, standard length, 30-degree scope, and a curved grasping forceps, and Ligasure V. At the end of the resection, a custom-made plastic bag was inserted in the abdomen through the 11mm trocar, and the specimen was morcellated at the umbilicus inside it without tearing. Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 114 minutes and laparoscopic time 96 minutes. Final umbilical incision length was 20mm. The patient’s pain medication could be kept low and the patient was discharged on the 5th postoperative day. After 6 months, the patient was well with no visible scar. Conclusion: Left hepatic lobectomy for benign lesions can safely be performed through transumbilical SIL. In the absence of malignancy, the final incision length can be kept minimal.

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Single incision transumbilical laparoscopic left hepatic lobectomy

Authors

G Dapri, V Donckier, J Himpens, GB Cadière

Abstract

Background: Single-incision laparoscopy (SIL) recently gained interest mainly to improve the cosmetic outcomes. This video shows a patient submitted to left hepatic lobectomy by transumbilical SIL.

Video: A 24 year-old woman with a BMI of 24.4 kg/m2 consulted for a hydatid cyst of the II-III hepatic segments. Preoperative work-up showed a hepatic hydatid cyst of the segment III, partially involving the segment II. A transumbilical SIL was performed using an 11mm trocar for a 10mm, standard length, 30-degree scope, and a curved grasping forceps, and Ligasure V. At the end of the resection, a custom-made plastic bag was inserted in the abdomen through the 11mm trocar, and the specimen was morcellated at the umbilicus inside it without tearing.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 114 minutes and laparoscopic time 96 minutes. Final umbilical incision length was 20mm. The patient’s pain medication could be kept low and the patient was discharged on the 5th postoperative day. After 6 months, the patient was well with no visible scar.

Conclusion: Left hepatic lobectomy for benign lesions can safely be performed through transumbilical SIL. In the absence of malignancy, the final incision length can be kept minimal.

Classification

single port, contribution

Keywords

Single incision, transumbilical laparoscopic left hepatic lobectomy

Media type

Surgical video

Duration

04'55''

Publication

2012-01

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E-publication

WeBSurg.com, Jan 2012;12(01).
URL: http://www.websurg.com/doi-vd01en3489.htm

Single incision transumbilical laparoscopic left hepatic lobectomy

1. Clinical case 00'00''

This 24 year-old lady presented with a hydatid cyst of the left liver lobe and we elected to perform a single incision approach. An intraumbilical incision was performed.

2. Trocar insertion 00'00''

A purse-string was placed and an 11mm trocar was inserted within that purse-string. A 30-degree angled optical system was inserted and the tumor, which was a hydatid cyst, was immediately visible.

3. Intraoperative ultrasonography 00'00''

We decided to perform an intraoperative ultrasonogram while in the left hand we were holding a double-curved grasper. A 5mm trocar was inserted in a superior left position. A 5mm scope was now used and the ultrasound probe was inserted through the 11m trocar. The probe confirmed the invasion of segments II and III. It also confirmed that the right lobe was entirely free. Dissection was initiated with the bipolar scissors. Adhesions with the stomach were severed.

4. Liver transection 00'00''

Subsequently, transection of the liver was started just to the left of the ligament and thanks to the bipolar tool, a virtually bloodless field was obtained. Thanks to the ideal optical conditions together with the perfect ergonomic conditions, the transection could be performed adequately in a very safe manner. One can appreciate the triangulation principle, which is still possible even in single incision approach thanks to the double-curved grasper, which is here held in the left hand. The dissection itself is performed by the surgeon’s right hand and the transection is driven towards the left suprahepatic vein, which is avoided. Eventually, the transection is completed. The triangular ligament is severed and the specimen is completely free.

5. Hemostatic gauze 00'00''

The hemostatic gauze is introduced inside the peritoneal cavity and placed on the section surface of the liver.

6. Specimen extraction 00'00''

A custom-made plastic bag is finally introduced and the specimen is placed inside, and then removed. After removal of the optics, the specimen is morcellated. The plastic bag is retrieved. The procedure is ended. The final incision’s length is exactly 2cm.