YoungRok Choi, Ho-Seong Han, Yoo-Seok Yoon, Jae Young Cho, Jae Seong Jand, Seong Wook Kwon, Sungho Kim, Jangkyu Choi. Seoul National University Bundang Hospital
Background: Laparoscopic major hepatecotmy through a single incision is difficult with limited activity ranges between an operator and assistants, instrument collision, unstable camera view. In this video, we introduced the solo single incision laparoscopic left hemihepatectomy using a laparoscopic passive scope holder. This solo hepatectomy using a single incision provides us a wide range of activity, collision between a camera and laparoscopic instruments and stable surgical views.
Video contents: A patient was in supine position with the legs split apart. An operator was between patients’ legs during operation. A laparoscopic scope holder was positioned in the left side of the patient. A 10mm flexible laparoscopic camera was fix using a jaw of a camera holder. It provided the stable laparoscopic surgical views. A 2.5cm sized single incision through an umbilicus was made. After ligating cystic artery and cystic duct, liver was retracted to the right side. After ligating left hepatic artery and left portal vein, liver ischemic line was marked on the liver surface. Without pringle’s maneuver, superficial parenchymal dissection was dissected with an energy device and deep part of the liver was dissected with a CUSA. During performing left hepatectomy, left side of middle hepatic vein was exposure and saved. Left bile duct isolated under the blunt dissection, it was identified and resected. At the conjoint point between middle hepatic vein and left hepatic vein, left hepatic vein was ligated and resected. A specimen with a gallbladder was removed though the umbilical wound.
This operation took 165 minutes and estimated blood loss was 300 mL. The patient was discharged 3 days after operation without a postoperative complication. Biliary intraepithelial neoplasia (grade 2) with 1.3cm resection margin was reported.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78862
Program Number: V015
Presentation Session: HPB
Presentation Type: Video