Single-incision Transumbilical Laparoscopic Left Hepatic Lobectomy and Nissen Fundoplication

Giovanni Dapri, MD FACS FASMBS, Vincent Donckier, MD PhD, Jacques Himpens, MD, Guy Bernard Cadière, MD PhD. European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium

 

Background: Single-incision laparoscopy (SIL) recently gathered interest mainly to improve the cosmetic outcomes. This video shows a patient submitted to left hepatic lobectomy together with Nissen fundoplication through transumbilical SIL.
Video: A 24 year-old female with a body mass index of 24.4 kg/m2 consulted for a hydatid cyst of the II-III hepatic segments and symptomatic gastroesophageal reflux. Preoperative work-up showed an hepatic hydatid cyst of the segment III, partially involving the segment II, associated to grade B esophagitis and hiatal hernia. A transumbilical SIL was performed using a standard 11-mm trocar for a 10-mm, 30° and standard length scope, LigaSure V, and curved reusable instruments inserted transumbilically without trocars. At the end of the hepatic resection, the specimen was morcellated at the umbilicus inside a custom-made plastic bag without tearing.
Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 214 minutes, with a laparoscopic time for hepatectomy 96 minutes, and for Nissen fundoplication 100 minutes. Final umbilical incision length was 20 mm. The patient’s pain medication could be kept low and the patient was discharged on 5th postoperative day. After 6 months the patient was asymptomatic, 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. Nissen fundoplication is actually facilitated by hepatic resection.


Session Number: VidTV3 – Video Channel Rotation Day 3
Program Number: V128

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