Transumbilical single-incision laparoscopic resection of focal hepatic lesions.
OBJECTIVE
Transumbilical single-incision laparoscopic surgery (SILS) is gaining in popularity as a minimally invasive technique. The reduced pain and superior cosmetic appearance it affords make it attractive to many patients. For this study, we focused on SILS, analyzing the outcomes of transumbilical single-incision laparoscopic liver resection (SILLR) achieved at our institution between January 2010 and February 2013.


METHODS
Pre- and postoperative data from 17 patients subjected to transumbilical SILLR for various hepatic lesions (8 hemangiomas, 2 hepatocellular carcinomas, 2 metastases, 2 calculi of left intrahepatic duct, and 3 adenomas) were assessed. Altogether, eight wedge resections, seven left lateral lobectomies, a combination wedge resection/left lateral lobectomy, and a proximal left hemihepatectomy segmentectomy were performed, as well as four simultaneous laparoscopic cholecystectomies. In each instance, three ports were installed through an umbilical incision. Once vessels and bleeding were controlled, the lesion(s) were resected with 5-mm margins of normal liver. Resected tissues were then bagged and withdrawn through the umbilical incision. The follow-up period lasted for a minimum of 6 months.


RESULTS
All 17 patients were successfully treated through a single umbilical incision. The procedures required 55 to 185 minutes to complete, with blood loss of 30 to 830 mL. Subjects regained bowel activity 0.8 to 2.3 days postoperatively and were discharged after 3 to 10 days. There were few complications (23.5%), limited to pleural effusion, wound infection, and incisional hernia.


CONCLUSIONS
Transumbilical SILLR is challenging to perform through conventional laparoscopic instrumentation. The risk of bleeding and technical difficulties is high for lesions of the posterosuperior hepatic segment. Surgical candidates should be carefully selected to optimize the benefits of this technique.
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Shuodong
S
Wu
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Xiao-Peng
XP
Yu
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Yu
Y
Tian
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Ernest Amos
EA
Siwo
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Yongnan
Y
Li
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Hong
H
Yu
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Dianbo
D
Yao
Department of Minimally Invasive Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Chao
C
Lv
D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014472:Umbilicus / Q000601:surgery*
Hepatectomy; Laparoscopy; Single-incision surgery