Laparoscopic resection of giant hepatic cystadenoma
Epublication WebSurg.com, Oct 2012;12(10). URL: http://websurg.com/doi/vd01en3781
This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.