Shu-Hung Chuang, MD, PhD, Dev-Aur Chou, MD, Shih-Wei Huang, MD, Min-Chang Hung, MD, Jimmy Chunmin Su, MD, Hurng-Sheng Wu, MD. 1. Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan 2. IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
INTRODUCTION: Single-incision laparoscopic surgery or laparoendoscopic single-site surgery is an alternative to conventional multiple-incision laparoscopic surgery in various fields. The application of this novel technique to complicated hepatectomy has been reported in only a few cases in the literature.
METHODS AND PROCEDURES: A 73 y/o female case of chronic hepatitis C and liver cirrhosis was diagnosed as having a 3 cm deep located hepatocellular carcinoma (HCC) at segment 4a by computed tomography. Her indocyanine green (ICG) retention rate at 15 minutes was 23.14%. Under 3D guidance based on computed tomography image, single-incision laparoscopic anatomical resection of segment 4 and cholecystectomy was performed via a 4-cm lower midline incision. Without Pringle maneuver, the liver parenchyma was dissected by a harmonic scalpel with clamp-crush technique; the major vessels and bile ducts were controlled by linear staplers or endoclips. The operative time was 540 mins and the estimated blood loss was 500 ml. The pathologic report showed a 2.9×2.9×2.7 cm grade 2 HCC with a free resection margin. She was discharged on the postoperative day (POD) 10 due to transient moderate ascites. The drain was removed at the outpatient department on POD 18. No tumor recurrence was found to date (6 months after the operation).
CONCLUSION: Single-incision laparoscopic anatomical liver resection under 3D guidance based on computed tomography image is feasible and safe for cirrhotic patients with deep located hepatocellular carcinomas by experienced single-incision laparoscopic surgeons. The promising result of applying this technique to other complicated liver resections could be anticipated.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88599
Program Number: V122
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo