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Vincent DONCKIER

Erasme University Hospital
Brussels, Belgium
MD, PhD
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Transumbilical single incision laparoscopic pericystectomy of liver segment 7
Background: Transumbilical single incision laparoscopy has recently sparked interest mainly to improve cosmetic outcomes, while other potential advantages are currently under evaluation. This video presents a pericystectomy of liver segment 7 performed in a patient with a hydatic cyst.

Clinical case: A 26-year-old female, without any surgical history but with a body mass index of 20.6 kg/m2 consulted for a hepatic lesion. Preoperative work-up showed a hydatic cyst of liver segment 7 with renal adhesions. The procedure was performed using an 11mm reusable port to accommodate a 10mm, 30-degree standard length scope, reusable curved instruments according to Dapri (Karl Storz Endoskope), and a straight Ligasure™ V (Covidien). Intraoperative ultrasonography allowed to identify the edges of pericystectomy. The specimen was retrieved through the umbilicus in a custom-made plastic bag, and morcellated at that level.

Results: No conversion to open surgery nor insertion of additional ports were necessary. Laparoscopy took 160 minutes, and the final umbilical incision length was 16mm. Pathologic data confirmed the presence of a hydatic cyst. The patient was discharged on postoperative day 5.

Conclusions: Transumbilical single incision laparoscopy is beneficial in liver surgery for benign lesions, due to minimal final scar length, which has cosmetic as well as additional potential advantages that need to be further investigated.
Surgical intervention
6 years ago
2821 views
66 likes
0 comments
05:40
Transumbilical single incision laparoscopic pericystectomy of liver segment 7
Background: Transumbilical single incision laparoscopy has recently sparked interest mainly to improve cosmetic outcomes, while other potential advantages are currently under evaluation. This video presents a pericystectomy of liver segment 7 performed in a patient with a hydatic cyst.

Clinical case: A 26-year-old female, without any surgical history but with a body mass index of 20.6 kg/m2 consulted for a hepatic lesion. Preoperative work-up showed a hydatic cyst of liver segment 7 with renal adhesions. The procedure was performed using an 11mm reusable port to accommodate a 10mm, 30-degree standard length scope, reusable curved instruments according to Dapri (Karl Storz Endoskope), and a straight Ligasure™ V (Covidien). Intraoperative ultrasonography allowed to identify the edges of pericystectomy. The specimen was retrieved through the umbilicus in a custom-made plastic bag, and morcellated at that level.

Results: No conversion to open surgery nor insertion of additional ports were necessary. Laparoscopy took 160 minutes, and the final umbilical incision length was 16mm. Pathologic data confirmed the presence of a hydatic cyst. The patient was discharged on postoperative day 5.

Conclusions: Transumbilical single incision laparoscopy is beneficial in liver surgery for benign lesions, due to minimal final scar length, which has cosmetic as well as additional potential advantages that need to be further investigated.
Single incision transumbilical laparoscopic left hepatic lobectomy
Background: Single-incision laparoscopy (SIL) recently gained interest mainly to improve the cosmetic outcomes. This video shows a patient submitted to left hepatic lobectomy by transumbilical SIL.

Video: A 24 year-old woman with a BMI of 24.4 kg/m2 consulted for a hydatid cyst of the II-III hepatic segments. Preoperative work-up showed a hepatic hydatid cyst of the segment III, partially involving the segment II. A transumbilical SIL was performed using an 11mm trocar for a 10mm, standard length, 30-degree scope, and a curved grasping forceps, and Ligasure V. At the end of the resection, a custom-made plastic bag was inserted in the abdomen through the 11mm trocar, and the specimen was morcellated at the umbilicus inside it without tearing.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 114 minutes and laparoscopic time 96 minutes. Final umbilical incision length was 20mm. The patient’s pain medication could be kept low and the patient was discharged on the 5th postoperative day. After 6 months, the patient was well with no visible scar.

Conclusion: Left hepatic lobectomy for benign lesions can safely be performed through transumbilical SIL. In the absence of malignancy, the final incision length can be kept minimal.
Surgical intervention
7 years ago
2710 views
25 likes
0 comments
05:12
Single incision transumbilical laparoscopic left hepatic lobectomy
Background: Single-incision laparoscopy (SIL) recently gained interest mainly to improve the cosmetic outcomes. This video shows a patient submitted to left hepatic lobectomy by transumbilical SIL.

Video: A 24 year-old woman with a BMI of 24.4 kg/m2 consulted for a hydatid cyst of the II-III hepatic segments. Preoperative work-up showed a hepatic hydatid cyst of the segment III, partially involving the segment II. A transumbilical SIL was performed using an 11mm trocar for a 10mm, standard length, 30-degree scope, and a curved grasping forceps, and Ligasure V. At the end of the resection, a custom-made plastic bag was inserted in the abdomen through the 11mm trocar, and the specimen was morcellated at the umbilicus inside it without tearing.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 114 minutes and laparoscopic time 96 minutes. Final umbilical incision length was 20mm. The patient’s pain medication could be kept low and the patient was discharged on the 5th postoperative day. After 6 months, the patient was well with no visible scar.

Conclusion: Left hepatic lobectomy for benign lesions can safely be performed through transumbilical SIL. In the absence of malignancy, the final incision length can be kept minimal.