Transumbilical single-incision laparoscopic fundoplication: a new technique for liver retraction using cyanoacrylate.
OBJECTIVE
Single-incision laparoscopic fundoplication is not widespread because of its technical difficulty. An additional stay suture or retractor is often needed for liver retraction during the procedure. Here, we share our 7 cases to demonstrate the feasibility of transumbilical single-incision laparoscopic fundoplication with a new technique for liver retraction without any stay suture or retractor.


METHODS
From March 2010 to October 2011, 3 patients with achalasia underwent a transumbilical single-incision laparoscopic Heller-Dor operation, and 4 patients with hiatus hernia underwent transumbilical single-incision laparoscopic hernioplasty and Nissen fundoplication. The procedures were attempted transumbilically by using three rigid trocars (one was 10 mm, and two were 5 mm) inserted through the 2-cm umbilicus incision. Conventional laparoscopic instruments were used. Adequate retraction of the liver was achieved by binding the lateral left lobe of the liver to the diaphragm with cyanoacrylate.


RESULTS
The pneumoperitoneal time was 115-170 minutes, and blood loss was 15-50 mL. There were no intra- or postoperative complications. The hospital stay was under 6 days for all patients. The umbilical incision healed well with satisfactory cosmetic effect.


CONCLUSIONS
The transumbilical single-incision laparoscopic technique in the treatment of achalaisa and hiatus hernia is feasible for an experienced laparoscope surgeon with excellent cosmetic effect. Cyanoacrylate, when used as described, offers a safe and simple solution to the problem of liver retraction, thus obviating the need for a stay suture or liver retractor.
Department of Minimally Invasive Surgery, Sheng Jing Hospital of China Medical University, Shenyang City, Liaoning Province, People’s Republic of China.
Ying
Y
Fan
Shuo-Dong
SD
Wu
Jing
J
Kong
Yang
Y
Su
Yu
Y
Tian
D000293:Adolescent; D000328:Adult; D000368:Aged; D003487:Cyanoacrylates; D004931:Esophageal Achalasia / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014472:Umbilicus
D003487:Cyanoacrylates