Single-port Laparoscopic Hepatectomy (with Video)

Mitsuhiro Asakuma, PhD MD, Koji Komeda, PhD MD, Yoshiharu Miyamoto, PhD MD, Fumitoshi Hirokawa, PhD MD, Tetsunosuke Shimizu, PhD MD, Yoshihiro Inoue, PhD MD, Michihiro Hayashi, PhD MD, Kazuhisa Uchiyama, PhD MD. Osaka Medical College

 

Introduction: We provide an initial report of the indications and procedures for single-port laparoscopic hepatectomy.
Methods: Laparoscopic hepatectomy and single port laparoscopic surgery has been performed in 64 patients and 129 patients respectively at our institution. Among them, we experienced 8 cases of single port hepatectomy. Five cases (benign tumor: 2 cases, metastatic liver tumor: 3 cases) of partial resection and 3 cases (metastatic liver tumor: 2 cases, Hepatocellular carcinoma: 1 case) of lateral segmentectomy were performed. A surgical glove port was used and the patient was placed in the French position with the surgeon between the legs in all the cases. 2.0 cm long incision for the port was made on the umbilicus. Parenchyma without significant structure was divided using laparoscopic coagulating shears (LCS) while an Echelon FlexTM was used for significant vessels such as Glisson’s sheath or root of hepatic vein. Specimens were retrieved through the umbilical incision. The incisions were extended until the size of specimen.
Results: All the procedures were successfully done by single port fashion, without any additional port. The mean operation time was 141min and the mean bleeding was 41ml. No post-operative complications occurred. The patient was able to resume an oral diet and full mobility free of opioid analgesia on the first postoperative day. The resection margin was clear.
Video :( please refer accompanied video) (case No.3) A 66-year old man who was diagnosed metastatic liver tumor n S3. Operation was done by single port using surgical glove method. (case No.5) A 73-year old woman, diagnosed as metastatic liver tumor (S2), was performed single port partial resection via umbilical 2.0cm incision. (case No.4) A 62-years old woman who had metastatic liver tumor (S2.3), was underwent single port lateral segmentectomy of the liver.
Conclusions: Single port surgery is a new method of laparoscopic surgery which does not establish yet. So its indications have to be strict. From our limited experiences, it is important that resection surface should be a simple flat plane which can be straightly approached from the umbilicus. Or tumor located peripheral of the normal liver, though estimated plane is curved, could be also good candidate for this approach. Because safety is primly important factor to be assured, we have kept these criteria for single port hepatectomy. From the result of our series, all the operations have performed without blood transfusion and mean operative time was 141min. This is, we consider, the adequate consequence of our strict indication. The problem of this approach might be uncleanness of the benefit over the conventional method except cosmetic benefit. Time is too fast to define the conclusion, while some RCT is ongoing to answer this question. Thus single port hepatectomy have great potential to be a new less invasive surgery.
 


Session Number: SS19 – Videos: HPB (Hepatobiliary and Pancreas)
Program Number: V037

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