Laser resection of a liver hydatid cyst under videolaparoscopy

Abstract

Total pericystectomy is the surgical method of choice for hepatic hydatid disease. This was performed under videolaparoscopy using the neodymium yttrium-aluminium-garnet (NdYAG) laser, allowing safe control of all vasculobiliary structures entering the pericyst. Case reportA 50-year-old north African man in good general condition was admitted in January 1991. He complained of pain in the right upper quadrant of the abdomen, radiating to the right shoulder. He had neither jaundice nor fever. His eating habits included consumption of raw lamb. Blood tests showed a slight eosinophilia with moderate hyperleucocytosis, but results of liver function tests were normal. Abdominal ultrasonography and computed tomography showed a partially calcified mass of the left hepatic lobe, measuring about 6 cm in diameter. The suspected hydatid nature of this mass was confirmed by specific immunological evaluation, particularly the indirect haemagglutination test and immunoelectrophoresis. As this symptomatic hydatid cyst was favourably located at the anterior edge of the left lobe, surgical resection under videolaparoscopy was undertaken. The operation, consisting of total pericystectomy using the NdYAG laser without opening the cyst, lasted for 160 min. The postoperative course was uneventful. Oral fluids were resumed the next day, and a solid diet was started on the second day after operation. The patient left the hospital on the third day after operation and returned to work 1 week after surgery. Histological examination of the cyst confirmed its hydatid nature. Surgical techniqueThe procedure uses the plane of cleavage close to the pericyst but outside the adjacent normal friable liver tissue, with step-by-step control of all veins and biliary ducts entering the pericyst ( Figure I ).The patient was prepared with legs apart, the surgeon standing between them. The first assistant or camera assistant stood at the right and the second assistant at the left. Two videomonitors were set on both sides of the anaesthetist to give a good view to the surgeon and the assistants. The patient was surgically draped to allow immediate laparotomy if needed. The pneumoperitoneum was insufflated by puncture of the umbilicus and waselectronically controlled at 13 mmHg of constant abdominal pressure. The peroperative monitoring during general anaesthesia included capnography and saturometry. The straight telescope (0") attached to a videocamera (Karl Storz, Tuttlingen, Germany) was inserted through a 10-mm trocar and abdominal exploration was performed first. The hydatid cyst was not visible, hidden under inflammatory adhesions. A search for another intra-abdominal localization of the parasite was negative. Three other trocars were then inserted. One 10-mm trocar inserted 5 cm to the left of the umbilicus was to provide an operating channel for endoscopic surgical instruments, such as the electrical hook cannula, scissors, special cannula for the NdYAG laser fibre, and the Endoclip clip applicator (US Surgical, Norwalk, Connecticut, USA). A 5-mm t...

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