title: Large subcapsular liver hematoma following single-incision laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Many laparoscopic surgeons are now transitioning from standard multiple-port laparoscopic cholecystectomy to single-incision laparoscopic surgery (SILS) in an attempt to improve cosmetic outcomes and decrease postoperative morbidity. However, little has been published regarding the potential complications of SILS operations.
  
  
  METHODS
  We report the case of a patient undergoing SILS cholecystectomy who developed the complication of a large hepatic hematoma, resulting in significant postoperative morbidity, blood transfusion requirement, and reoperation.
  
  
  RESULTS
  After an in-depth internal review of the postoperative morbidity of this case, it appears that the causative factor may be instrument shaft torque on the liver surface.
  
  
  CONCLUSIONS
  Single-incision laparoscopic surgery may pose significant and unique risks that warrant additional operative caution. Quantitative comparison of SILS to the gold-standard laparoscopic cholecystectomy is needed to further elucidate definitive benefits and complications of this novel technique.
authors: Department of Surgery, The University of Arizona College of Medicine, Tucson, Arizona 85724-5058, USA.
authors: Adam J
authors: AJ
authors: Hansen
authors: Julie
authors: J
authors: Augenstein
authors: Evan S
authors: ES
authors: Ong
mesh_terms: D000328:Adult; D001657:Biliary Dyskinesia / Q000601:surgery*; D001803:Blood Transfusion; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000601:surgery; D008099:Liver / Q000293:injuries*; D008107:Liver Diseases / Q000209:etiology* / Q000601:surgery; D012086:Reoperation