Method of Expanding Applications in Single Incisional Laparoscopic Hepatectomy: The Utility of Radio Wave Pre-Coagulation and Soft Coagulation

Mitsuo Miyazawa, MD PhD FACS, Masayasu Aikawa, MD PhD, Katsuya Okada, MD PhD, Yasuko Toshimitsu, MD PhD, Kojun Okamoto, MD PhD, Kenichirou Takase, MD, Shigeki Yamaguchi, MD PhD, Isamu Koyama, MD PhD. Saitama Medical University International Medical Center

Controlling bleeding is one of the several issues requiring breakthroughs to expand the application of single incisional laparoscopic hepatectomy (Slap H). A single incision compared to a multi-incisional hepatectomy is generally more difficult, and it is particularly difficult when it comes to controlling bleeding in cases of hemorrhage. Therefore, for Slap H that prevents hemorrhage as much as possible intraoperatively, pre-coagulation is done with radio waves on the circumferential hepatectomy line, and a procedure is carried out which crushes the cross-section of the liver with laparoscopic bipolar coagulation. There is a necrotic portion of the liver remaining after radio wave pre-coagulation, and although there are fears of post-operative liver ailments, there seems to be no issue as long as only one break is performed, even if the circumference of the edge that is cut is operated on. (World J Surg, 2007)
At this time we have conducted a single incisional partial hepatectomy with as little hemorrhage as possible, thus will report the results.
(Slap H) The patient was a 58 year old male having hepatitis C related cirrhosis with S5 hepatocellular carcinoma. An incision was made at the supraumbilical region (2 cm), and a SILS™ Port was inserted. The positional relationship between the large vessels and the tumor was determined with a laparoscopic echo. The tumor was S5 (2 cm in diameter) protruding slightly into the liver and the hepatectomy line was marked with an electrosurgical knife. An end retractor was used to apply traction on the gallbladder and it was confirmed that there was no large Glisson’s capsule and precoagulation was conducted along the hepatectomy line with cool-tip radio waves. Radio waves were emitted around the 1 break mark as well as the proximal portion of the tumor. The removal of the liver was continued by slowly crushing the liver parenchyma with a BiClamp. Crushing was done twice in the same region to promote sonoclot coagulation. The tissue sealed with the BiClamp was cut with scissors so that 2/3 of the liver would remain. There was 10 ml of blood output from the 235 minute operational procedure, and the patient was released on the eighth day from hospitalization. Controlling bleeding is essential in expanding the application of single an incisional laparoscopy in hepatectomy.