Abstract
Introduction:
For abdominal operations, single-incision laparoscopic surgery (SILS) is feasible. 1,2 However, SILS is technically challenging for hepatectomy because of the complexity of liver anatomy. 3 This video shows a 59-year-old man with multiple liver metastases in segments 3, 4, and 5 from rectal cancer who received single-incision plus one-port laparoscopic hepatectomy.
Methods:
A disposable single-incision multiport trocar was used through the previous 5-cm longitudinal incision at the midline of the upper abdomen. The single-incision device included access for the endoscope, surgeon's dominant operating device, and assistant's instrument. One 12-mm trocar inserted into the right upper quadrant served as the surgeon's assisted port. The falciform ligament, ligamentum teres hepatis, and omentum were mobilized and divided. After performing anterograde cholecystectomy, a 1-cm mark around the metastases was made using electrocautery.
The metastasis in segment 3 was removed with meticulous dissection and vessel ligation. Before the hepatectomy in segments 4 and 5 was performed, the hepatic hilum was occluded using a bulldog clip. During the resection, the bulldog clip was temporarily removed for 5 minutes when hepatic hilar occlusion time reached 15 minutes. The total occlusion time was 26 minutes. Meticulous hemostasis was performed using electrocautery and fibrillar absorbable hemostatic agents. After removing the specimens through the incision, a subhepatic drainage tube was placed through the right upper quadrant port.
Results:
Single-incision plus one-port surgeries have been performed in 35 patients (17 males and 18 females) from July 2021 to September 2022, including right hemicolectomy (6 cases), left hemicolectomy (5 cases), sigmoidectomy (10 cases), and anterior rectal resection (14 cases). The mean operating time and blood loss were 193 minutes and 42 mL, respectively. The mean postoperative stay was 6.6 days. The mean length of incision was 4.8 cm. In this case, no intraoperative or postoperative complications were observed.
The total operation time and blood loss were 205 minutes and 200 mL, respectively. The aspartate transaminase and alanine transaminase levels showed temporary abnormalities and normalized on postoperative day 5. The patient underwent an uneventful recovery and was discharged on postoperative day 7. Pathology analysis showed the metastatic adenocarcinoma without margin involvement. The patient underwent adjuvant chemotherapy of XELIRI at 1 month. MRIs showed free of disease at 3 months with decreasing CEA and CA 19-9 levels.
Conclusion:
Single-incision plus one-port laparoscopic hepatectomy for liver metastases is feasible in selected cases. The benefits of single incision include reduced hospital stays and cosmesis. Further research regarding learning curves will help the wide application of this technique.
No competing financial interests exist.
Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.
Source of Video:
Shanghai Changzheng Hospital, Shanghai, China.
Authors' Contributions:
H.Z. had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept, design, and supervision were contributed by H.Z. Acquisition, analysis, interpretation of data, drafting of the article, and critical revision of the article for important intellectual content were by all authors.
Ethical Approval:
This study was approved by the ethics committee of Changzheng Hospital.
Runtime of video: 6 mins 7 secs.
