title: Single-access transumbilical laparoscopic unroofing of a giant hepatic cyst using reusable instruments.
abstract: BACKGROUND
  Single-access laparoscopy has garnered growing interest in recent years in an attempt to improve cosmesis, reduce postoperative pain, and minimize abdominal wall trauma.
  
  
  METHODS
  A female patient suffering from a symptomatic giant biliary cyst of the liver segments 4-7-8 was admitted for transumbilical single-access laparoscopic cyst unroofing. The procedure was performed using a standard 11-mm reusable trocar for a 10-mm, 30 degree-angled, rigid scope and curved reusable instruments inserted transumbilically without trocars. Operative time was 90 minutes, and the final incision length was 14 mm. The use of minimal pain medication permitted discharge on the third postoperative day, and after 25 months, the patient remains asymptomatic with a no visible umbilical scar.
  
  
  CONCLUSIONS
  Giant biliary cysts can be removed by single-access laparoscopy. Because of this technique, surgeons work in ergonomic positions, and the cost of the procedure remains similar to that of the multitrocar technique. The incision length and the use of pain medication are kept minimal as well.
authors.affiliation: Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.net
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.forename: Matteo
authors.initials: M
authors.lastname: Barabino
authors.forename: Pietro
authors.initials: P
authors.lastname: Carnevali
authors.forename: Ion
authors.initials: I
authors.lastname: Surdeanu
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
authors.forename: Vincent
authors.initials: V
authors.lastname: Donckier
mesh_terms: D003560:Cysts / Q000601:surgery*; D004867:Equipment Design; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery*; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control