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
Source: PubMed


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.

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    • "Straight 5 mm Flexible Benign and Malignant 14 24.3 187 0 +@ 214 NA 5 # Zhao et al. [22] 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. [25] SILS port (Covidien) Straight 5 mm Flexible Benign and Malignant 8 NA 148 0 +@ 2 3 6 . 2 Pan et al. [28] 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. [26] various Straight and Articulating 5 mm Flexible Benign and Malignant 7 NA 142 # NA + 0 @ 200 # NA 3 # Gaujoux et al. [21] "
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