gms | German Medical Science

Background: Multi-incision laparoscopic liver resection (MILL) has become technically feasible and safe. Thus, MILL is favored by most experienced hepatobiliary centers for sectionectomy and hemihepatectomy in patients with lesions and benign tumors. Potential advantages over multi-incision laparoscopy were noted for reduced-incision laparoscopic approaches in extrahepatic abdominal surgery, e.g. a shorter operation time as well as improved convalescence and cosmetic results.

Materials and methods: We here report on our experiences with single-incision laparoscopic liver resection (SILL), exemplified in a case of single-port left lateral sectionectomy. Challenges and solutions are demonstrated in a sequential video using a standardized technique for left lateral liver resection comparing single port access with formal multiport laparoscopy. In this video, we report on a 37-year old woman, who presented with a large (9.2 cm diameter) and symptomatic hemangioma located in the left lateral liver section. SILL was performed assisted by a pneumoperitoneum using an umbilical Single-Port system. First, line of transsection was marked. Subsequently, coagulation was performed using a monopolar radiofrequency electrode (Cool-tip^TM Covidien, USA). Transection was performed without the need for titanium ligature clips or surgical sutures. The left hepatic vein was cut using an Endo-Stapler. Resected left lateral liver section was removed in a specimen retrieval bag through the Single-Port system.

Results: SILL was performed without the need for additional trocar insertion or additional devices. Operation time was 223 minutes. Blood loss was estimated with 200 ml. No blood transfusion was needed perioperatively. Histopathological examination confirmed the complete resection of a benign liver hemangioma. The patients could be discharged from the hospital on postoperative day (POD) 6. The patient presented at POD 30 as an outpatient in excellent general condition and without any complications. SILL was associated with excellent cosmetic results.

Conclusion: Few experiences exist in reduced-incision liver surgery and further standardization is urgently needed. SILL in combination with radiofrequency ablation is technically feasible and safe and might simplify anatomical liver resection. Further improvements in single-ports and used electrodes might bear the potential to further decrease operation times in SILL.