Abstract
Introduction:
Laparoscopic major hepatectomy through a single incision is difficult because of frequent instrument collisions and an unstable camera view. 1 –9 This video shows a novel method for laparoscopic liver resection to reduce these problems through a single incision.
Methods:
The patient was placed in supine position with the legs split apart. The operator was situated between the patient's legs during the operation. A laparoscopic scope holder was positioned on the left side of the patient. A 2.5 cm sized single incision through the umbilicus was made. A 10 mm flexible laparoscopic camera was inserted through a glove port and fixed using a jaw of a camera holder. After liver mobilization, the left liver was retracted to the right side using an endogrip. After ligating the left hepatic artery and left portal vein, the resection line was marked along the line of ischemic demarcation. The dissection was meticulously performed without inflow control (Pringle) after retracting the liver to the left. During the parenchymal dissection, the middle hepatic vein was traced to the inferior vena cava. The left bile duct was isolated and divided. At the junction between the middle and left hepatic veins, the left hepatic vein was resected. The specimen and the gallbladder were removed through the umbilical wound.
Results:
The operation took 165 minutes and the estimated blood loss was 300 mL. The patient was discharged 3 days after the operation without any postoperative complications. Pathology analysis showed biliary intraepithelial neoplasia (grade 2) with clear resection margins.
Conclusions:
The solo laparoscopic left hemihepatectomy using a scope holder can be performed for the highly selective patients under the stable surgical view. This procedure by the solo surgery can be a new option to reduce the technical problems in a single incisional hepatectomy.
Acknowledgments:
The authors thank Woo Chul Kim, MD, and So Hyun Kang, MD, for their help in improving the English in this article and recording a narration.
No competing financial interests exist.
Runtime of video: 8 mins 29 secs
This video was presented at the podium in SAGES 2017.
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