Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery

Abstract

BACKGROUND:Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS) has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH).PATIENTS AND METHODS:From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure™ (Covidien-Valleylab. Boulder. USA), Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.).RESULTS:Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min) and the mean estimated blood loss was 57 ml (range: 25-150 ml). The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days). Pathology identified three benign and four malignant liver tumours with clear margins.CONCLUSION:SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

The Role of the Single Incision Laparoscopic Approach in Liver and Pancreatic Resectional Surgery

“…Easily accessible, superficial lesions in segments II, III, IV, V, and VIII [20, 28] are preferable, even though bigger or more technically challenging resections for less favourably located tumours have been described with increased experience in the technique (Table 1). With regard to the size of the lesions, most groups adopted a cut-off of <2.5–5 cm in diameter for malignant and <10 cm for benign tumours [12, 14, 20–22, 27, 28, 31]. Resection of larger malignant lesions has also been described [15, 20, 22]; however the potential extension of the incision for extraction of large specimen defeats the purpose of SILS [27].…”

“…Even though liver resections in cirrhotics may pose a greater challenge, SILS has also been described in this group of patients. Nonetheless, most cases were limited to early Child's A stage patients [12, 20, 28, 31], with only 3 cases reported in Child's B [12, 31] and 1 case in a Child's C patient [31]. The small number of reported SILS liver resections in the literature precludes direct comparison with laparoscopic surgery.…”

Single incision laparoscopic liver resection (SILL) – a systematic review

“…The literature research revealed 343 articles, of which 16 [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ] met the inclusion criteria. One study [ 26 ] had to be excluded since the same patients were reported in another publication [ 27 ] (Figure 1 (Fig.…”

Enhanced recovery after surgery in laparoscopic gastric cancer surgery: Many questions, few answers

“…Although we note that the authors have professed high skill levels in performance of gastrectomy with D 2 lymphadenectomy, sans complications,[8] certain thoughts merit deep introspection:…”

“…[12] Interestingly, in the present article, only 42% of patients who underwent ERAS were Stage III suggesting that over 50% cases presenting to a government hospital were in Stages I and II. [8]Given the evolving concept of multidisciplinary approach to management of gastric cancer, the incorporation of data on neoadjuvant or adjuvant treatment would perhaps give us a comprehensive view of oncological outcomes, which should be at the centre of any study in oncology. [12]…”