Role of Laparoscopy in Hepatic Cyst Surgery

Abstract

Background: Hepatic cysts are detected incidentally in 2.5–5% of the population. Only about 15% of such cysts are symptomatic. Since laparoscopic deroofing for liver cysts was first described in 1991 there have been a number of reports of successful laparoscopic management of hepatic cysts, including the laparoscopic management of complex and parasitic cysts. Methods: A systematic review of English-language articles on the subject appearing in journals through May 2002 was conducted using the Medline database. Results: Only a minority of cystic liver lesions need treatment, and the therapeutic approach is guided by the type of cyst. Laparoscopic deroofing (combined with omentoplasty and/or oversewing) of uncomplicated liver cysts is associated with a recurrence rate of 10–25%, with less morbidity and mortality as compared to open surgery. On the other hand, treatment of complex liver cysts and hydatid cysts by laparoscopy is not considered a standard approach. Conclusion: The laparoscopic approach in uncomplicated but symptomatic liver cysts is effective, with low morbidity and mortality. Additional omentoplasty or oversewing appears to reduce the recurrence rate.

Treatment options for hepatic cystic echinococcosis

“…2,39 Laparoscopic drainage of hepatic hydatid cysts is a 'minimally invasive' surgical technique that appears safe and effective. [40][41][42][43][44][45] Whichever technique is used, a benzimidazole agent is best used before any surgery in an attempt to sterilize the cyst contents and reduce the risk of anaphylaxis and dissemination. 25 Meticulous packing of the operative field is necessary irrespective of the surgical technique employed, as is the use of solutions that kill the infective scoleces and protoscolices of the parasite residing within the hydatid cyst, or potentially leaking from the cyst during surgical manipulation.…”

Evaluation of 300 Minimally Invasive Liver Resections at a Single Institution

“…Whereas laparoscopic ablative procedures require laparoscopic surgical skills that may include operative ultrasonography and liver mobilization, they typically do not necessitate either hilar dissection or parenchymal transection. 2,3 In contrast, laparoscopic approaches to liver cysts [4][5][6] and wedge resection of peripheral solid tumors [7][8][9] may require more aggressive mobilization of the affected hemiliver(s) and transection of liver parenchyma and, therefore, are more technically demanding and potentially more hazardous. Anatomic hemihepatectomies require a clear understanding of liver anatomy, experience with liver surgery, and, additionally, the ability to deal laparoscopically with major vascular and biliary structures, both outside the parenchyma of the liver and during parenchymal transection.…”

Cystic formations of liver

“…При сомнениях в характере кистозного образования ис-пользование интраоперационного УЗИ позволяет выпол-нять безопасную тонкоигольную биопсию кистозного об-разования в бессосудистом участке с последующим цито-логическим и морфологическим исследованием [45]. Ин-траоперационное УЗИ позволяет также определить взаи-моотношение кистозного образования с крупными желч-ными протоками и сосудами печени, что помогает обе-спечивать безопасность резекции кистозного образования [68].…”