Transumbilical single-incision laparoscopic deroofing for hepatic and splenic cysts

Takeshi Gocho, MD, Takeyuki Misawa, MD, PhD, Koichiro Haruki, MD, PhD, Ryota Saito, MD, PhD, Tadashi Akiba, MD, PhD, Katsuhiko Yanaga, MD, PhD. Jikei University School of Medicine

Background and Objective: Laparoscopic deroofing has become a standard approach for symptomatic hepatic and splenic cysts because of the low recurrence rate and minimal postoperative pain. Recent interest in better cosmetic outcomes promoted single incision laparoscopic surgery (SILS) in a variety of target organs including deroofing of hepatic and splenic cysts. The aim of this study was to assess the feasibility and safety of single-incision laparoscopic (SIL) deroofing of hepatic and splenic cysts.

Patients and methods: Between February 2010 and Ausugt 2014, we performed 13 cases of SIL deroofing for symptomatic hepatic (11 cases) and splenic (2 cases) cysts. A SILSTM port was placed through a single intraumbilical skin incision. A flexible 5-mm laparoscope and an articulating grasper were used in addition to standard laparoscopic instruments. The cyst wall was dissected using a 5-mm bipolar vessel sealer.

Results: The patients’ median age was 57 (range, 29-73) years, and all but one was female. The median size of the cyst was 11.0 (range, 10.0-15.2) cm. SIL deroofing was successfully performed in all patients, and none required additional port or conversion to open surgery. Intraoperative blood loss was minimal in all cases. Median operative time was 145 (range, 100-152) min. A drain was inserted only in the first patient. Diet intake was started from the first postoperative day and all patients were discharged uneventfully with the mean hospital stay of 3.2±0.4 days. Median postoperative follow-up of 27 (range, 6-52) months did not reveal any complications nor recurrence. Postoperatively, the umbilical incision was almost unnoticeable in all cases.

Conclusion: SIL deroofing is technically feasible and has cosmetic benefit for patients with symptomatic hepatic and splenic cysts.

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