The utility of two incisional laparoscopic unroofing of liver cysts compared with single incisional laparoscopic surgery.

Jun Hanaoka, MD, PhD, Hideki Kawasaki, MD, PhD, Masamitsu Harada, MDPhD, Hiromi Otani, MD, PhD, Masahiko Fujii, MD, PhD, Kazunori Tokuda, MD. Ehime Prefectural Central Hospital

(Background)

The aim of this study is to introduce some operative skills of laparoscopic unroofing of liver cysts by 2 incision, and its utility compared with single incisional surgery in the treatment of huge liver cysts.

(Operating method)

Single incisional unroofing of liver cysts: The patients were placed in left hemi-lateral decubitus position for right lobe lesion of liver cysts. On the one hand, the patients were placed in dorsal position for left lobe lesion. Umbilical fold was cut about 2.5cm, then GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA) was inserted in the umbilical incision. Three ports for GelPOINT were set in a triangle position. Laparoscope was inserted in the caudal port. Left port was used for SILS forceps (COVIDIEN), and right port was used for energy device like LigaSure 5mm Blunt tip Laparoscopic Insturument (COVIDIEN) or HARMONIC ACE (ETHICON). Liver cysts were cut by energy device. After unroofing the liver cysts, whole area of inner cavity were cauterized by laparoscopic electrical cautery. And resected specimen was extracted by plastic bag from umbilical wound. The 5mm drain was inserted in the cavity at epigastric region.

Two incisional unroofing of liver cysts: After inserting of GelPOINT, one more port (5mm) was added at epigastric region. Above mentioned energy devices were used by the added port, and liver cysts were treated in the same manner.

(Patients and methods)

From April 2009 to August 2014, 9 patients underwent laparoscopic liver cyst unroofing in Ehime prefectural central hospital, Japan. All the clinical data were retrospectively analyzed. Seven liver cyst patients were received two incisional laparoscopic liver cyst unroofing at our hospital, and 2 liver cyst patients were received single incisional laparoscopic liver cyst unroofing. Patient background like age, sex, body height, body weight, BMI, nature of cyst, hepatic functional reserve, etc, was analyzed. And the factor about surgery like blood loss and operative time. Moreover, recovery time of gastrointestinal function, volume of postoperative drainage, postoperative drainage time, postoperative hospitalization time, and postoperative recurrence rate were compared between the two groups.

(Results)

There were no differences in patient background between two groups. In the factor of surgery, operative time was significantly shorter and blood loss was lesser in the 2 incisional unroofing group. There was no difference in recovery time of gastrointestinal function, volume of postoperative drainage, postoperative drainage time, postoperative hospitalization time, and postoperative recurrence rate. Moreover, because the drain was inserted by using the wound of 5mm of the epigastric port, final scar after two incisional surgery was same with single incisional surgery.

(Conclusion)

Compared with single incisional unroofing of liver cysts, two incisional unroofing of liver cysts was safety and speedy. Moreover, because the scar of two incisional unroofing of liver cysts was same with single incisional surgery, it is recommended method for huge liver cysts.

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