Single Incision Laparoscopic Partial Hepatectomy

Introduction: Hepatocellular carcinoma is one of the most common tumors worldwide, commonly arising in the presence of hepatitis with or without cirrhosis. Open and laparoscopic approaches to resection have been described. We report a case of a hepatocellular carcinoma completely resected laparoscopically via a single incision approach.
Methods: A 58-year-old female with past medical history significant for hepatitis C and cirrhosis presented with a newly diagnosed hepatocellular carcinoma. Since the patient was in overall good health and had a tumor in the left lateral segment of the liver, laparoscopic surgery was considered. Given the moderate size of the tumor and the favorable location within the left lateral segment with respect to acquisition of acceptable margins, the decision was made to perform the novel approach of multiple ports via a single incision.
In the operating room, a single transverse, infraumbilical incision was created through which four laparoscopic ports were introduced – two 5-mm and two 12-mm. A 5-mm laparoscope was employed; the Harmonic scalpel was used to score the capsule of the liver. The laparoscopic ultrasound was utilized to map the margins of resection. A laparoscopic stapler, in combination with the Harmonic scalpel was used to transect the liver parenchyma. Complete resection was noted with the ultrasound guidance and the specimen was sent to pathology. Hemostasis was achieved with electrocautery, FloSeal and SurgiCel.
Results: The patient recovered without complications. She reported minimal postoperative pain. She was discharged home on postoperative day 3. The final pathology showed a moderately to poorly differentiated T1 hepatocellular carcinoma with negative margins.
Conclusion: Single incision laparoscopic surgery is a new technique that is emerging as an alternative to standard laparoscopic surgery. The potential for less pain and faster recovery is a factor in considering this approach. Single incision partial hepatectomy is a new procedure than can be considered in appropriate candidates. While some of the emerging single port trocars allow for multiple instruments to pass through a single access device, this is not recommended for single-incision liver surgery at the current time as two 12-mm trocars are needed simultaneously for the ultrasound and the stapler.

Session: Video Channel

Program Number: V081

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