Single Incision Laparoscopic Liver Resection in Porcine Model

Toshio Katagiri, MD, Takayuki Dotai, MD, Anibal Rondan, MD, Sheetal Nijhawan, MD, Saniea Majid, MD, Michael Sedrak, MD, Bryan Sandler, MD, Garth R Jacobsen, MD, Santiago Horgan, MD, Mark A Talamini, MD. University of California San Diego

Introduction: Single Incision Laparoscopic Surgery (SILS) is a rapidly evolving field. It is an important bridge between laparoscopic and natural orifice translumenal endoscopic surgery. Liver resection is a high technique demanding surgery for the risk of hemorrhage and is rarely performed even by laparoscopic surgery. Given this, SILS liver resection is hence even less popular. Up to date there are only few published reports in the literature. It is clearly an emerging technique that deserves more attention. This report demonstrates a SILS partial liver resection performed safely using articulating instruments in porcine model.Methods: A non-survival acute porcine model with general anesthesia was utilized in this case. The animal was cared for according to University of California San Diego Institutional Animal Care and Use Committee approved protocol. A single 2.5 cm umbilical incision was made. An umbilical SILS port was placed under direct visualization and used to establish pneumoperitoneum. The animal was kept in a reverse Trendelenburg position throughout the procedure. A 5mm 30 degree laparoscope and a flexible grasper were inserted via the umbilical port. The gallbladder was retracted using the flexible grasper. Flexible linear staplers were used to perform the wedge hepatic resection. Intraoperative hemorrhage during this resection was controlled using a tissue sealing device. An endobag was inserted and the specimen was placed into the endobag for extraction. The specimen was easily removed from umbilical incision. Results: The SILS partial liver resection was successfully performed. There were no intraoperative complications. Operating time was 45 minutes. Intraoperative blood loss was 30ml. The specimen was 11.0×4.0cm in diameter. At necropsy, the stapling line was completely intact, with no evidence of bile leak.Conclusion: The SILS liver resection is significantly limited by the technical difficulty encountered during transaction of substantial liver parenchyma, with intraoperative hemorrhage and bile leaks. Technical challenges encountered can be minimized with the use of flexible staplers and articulating instruments. A careful translation to the human arena will be cautiously pursued.