Laparoendoscopic single-site liver resection: A preliminary report of 12 cases
Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing, China. Surgical Endoscopy
(Impact Factor: 3.26).
05/2011; 25(10):3286-93. DOI: 10.1007/s00464-011-1706-1
Laparoendoscopic single-site (LESS) surgery is an emerging laparoscopic procedure previously used for cholecystectomy and appendectomy. However, few studies have examined LESS liver resection, and its benefits require investigation. This study aimed to evaluate the feasibility and safety of LESS liver resection.
From December 2009 to October 2010, 12 patients were selected for LESS liver resection with institutional review board approval. The LESS technique was performed using a transumbilical TriPort or three 5-mm trocars with a 5-mm linear or flexible laparoscope. Conventional or articulating laparoscopic instruments were used to mobilize and transect the lesions.
The LESS liver resection procedure was successfully completed for 10 patients (83.3%), with the remaining 2 patients (16.7%) undergoing conversion to conventional multiport laparoscopy. The procedures consisted of left lateral segment resection (n = 4) and partial resection (n = 8) in addition to concomitant cholecystectomy (n = 3). The mean operative time was 80.4 min (range, 35-160 min), and the mean estimated blood loss was 45 ml (range, 20-800 min). No postoperative complications were noted except for biliary leakage (200 ml/day)in one patient. The mean hospital stay was 4.3 days (range, 2-8 days). No patient required postoperative analgesia, and the pain visual analog score 48 h after surgery was 0.53 (range, 0-2). Pathology identified 10 benign and 2 malignant liver tumors with a clear margin.
Our preliminary data show that LESS liver resection is safe and feasible for selected patients, with potential benefits that include a fast recovery, light pain, and cosmetically acceptable scarring. However, this procedure requires advanced instruments and complicated laparoscopic techniques, with a risk of intraoperative bleeding and postoperative bile leakage.
Available from: ncbi.nlm.nih.gov
- "Straight 5 mm Flexible Benign and Malignant 14 24.3 187 0 +@ 214 NA 5 # Zhao et al.  Triport (ACS), 5-5-5 mm trocars Straight and Articulating 5 mm Rigid and Flexible Benign and Malignant 12 26.3 80.4 16.7 + 0 @ 45 2.5 4.3 Aikawa et al.  SILS port (Covidien) Straight 5 mm Flexible Benign and Malignant 8 NA 148 0 +@ 2 3 6 . 2 Pan et al.  10 mm and 5 mm trocars Straight 10 mm Benign and Malignant 8 26.2 89.7 0 +@ 64.3 2.5 3.7 Tan et al.  various Straight and Articulating 5 mm Flexible Benign and Malignant 7 NA 142 # NA + 0 @ 200 # NA 3 # Gaujoux et al.  "
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ABSTRACT: Background. Single-incision transumbilical laparoscopic liver resection (SITLLR) has been recently described in limited series. We report our experience in SITLLR and discuss the future of this approach in terms of indications, potential benefits, and limitations, with a special reference to laparoscopic liver resection (LLR). Patients and Methods. Six patients underwent SITLLR. Indications were biliary cysts (3 cases), hydatid cysts (2), and colorectal liver metastasis (1). Procedures consisted in cysts unroofing, left lateral lobectomy, pericystectomy, and wedge resection. SITLLR was performed with 11 mm reusable trocar, 10 or 5 mm 30° scopes, 10 mm ultrasound probe, curved reusable instruments, and straight disposable bipolar shears. Results. Neither conversion to open surgery nor insertion of supplementary trocars was necessary. Median laparoscopic time was 105.5 minutes and median blood loss 275 mL. Median final umbilical scar length was 1.5 cm, and median length of stay was 4 days. No early or late complications occurred. Conclusion. SITLLR remains a challenging procedure. It is feasible in highly selected patients, requiring experience in hepatobiliary and laparoscopic surgery and skills in single-incision laparoscopy. Apart from cosmetic benefit, our experience and literature review did not show significant advantages if compared with multiport LLR, underlying that specific indications remain to be established.
Available from: Jose Ignacio Fernandez
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ABSTRACT: Background: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplified sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS® or GelPoint® multiport, and a 5mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confirming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m2. Mean operative time was 56.4 ± 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 ± 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left flank simplifies the procedure, allowing the use of rigid instruments.
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Acute small bowel obstruction (SBO) is a common cause of emergency hospital admission, often requiring surgical intervention. Herein, we describe the single-incision laparoscopic surgery (SILS) procedure for the management of SBO in the acute care setting.
Patients and methods:
Patients with intestinal obstruction who underwent SILS in Chang Gung Memorial Hospital, Linkou, Taiwan, from January 2010 to January 2012 were retrospectively analyzed. Informed consent was obtained from all patients. Demographic information, intraoperative findings, surgery duration, and conversion to multi-incision laparoscopic surgery (MILS) were recorded. Postoperative records included the recovery period after surgery, complications, length of hospital stay, and final prognosis.
Ten SILS procedures for the repair of SBO were performed (six women, four men; median age, 52 years [range, 28-89 years]). Only 1 patient (10%) required conversion to MILS. The median operative time was 140 minutes (range, 90-210 minutes), median time to resume oral intake was 3 days (range, 1-7 days), median time to ambulation was 3 days (range, 1-6 days), and median postoperative hospital stay was 7.5 days (range, 3-14 days). There was no mortality in this series. All patients were discharged uneventfully. The umbilical incision was nearly invisible at the 1-month follow-up. The median follow-up time was 13.5 months (range, 4-26 months). No incisional hernias or adhesions were observed.
SILS for SBO is a feasible, safe procedure that can be performed as initial treatment in select patients with bowel obstruction through resection and decompression of the small bowel using intra- or extracorporeal techniques, resulting in a nearly invisible scar.
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