Inline radiofrequency pre-coagulation simplifies single-incision laparoscopic minor liver resection.
BACKGROUND
Single-incision laparoscopy (SIL) has been developed to reduce surgical trauma, whereas technical difficulties in bleeding control limit the broad acceptance for hepatectomy. A novel minimized invasive strategy combining inline radiofrequency pre-coagulation and transumbilical SIL is presented herein.


METHODS
A cohort of 21 selected patients underwent transumbilical SIL hepatectomies (segmentectomies II-VI) utilizing inline radiofrequency pre-coagulation for hepatic transection (Habib 4X). Bleeding control, postoperative complications and positive resection margins in malignant diseases served as primary and secondary outcome parameters, respectively.


RESULTS
Single-incision laparoscopy was successfully completed in all patients. A total of 33 segments were retrieved: mean resection time was 66 ± 35 min, including 11 anatomical (52.38%) and 10 non-anatomical (47.62%) resections. Sixteen patients (76.19%) underwent concomitant abdominal surgery. No substantial blood loss occurred. Neither additional staplers nor clips were necessary to control any bleeding or bile leakage. One pleural effusion counted for the only postoperative complication. Free margins could be achieved in all but one resection (12/13 patients with malignancies; 92.31%). Ninety-day mortality was zero.


CONCLUSIONS
The combination of SIL and inline radiofrequency pre-coagulation proved to be a simple, efficacious and safe technique in minor hepatectomy.
Surgical Department, Saint John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria.|Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Salzburg, Austria.
Michael
M
Weiss
Surgical Department, Saint John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria.|Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Salzburg, Austria.
Christof
C
Mittermair
Surgical Department, Saint John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria.|Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Salzburg, Austria.
Eberhard
E
Brunner
Surgical Department, Saint John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria.|Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Salzburg, Austria.
Jan
J
Schirnhofer
Surgical Department, Saint John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria.|Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Salzburg, Austria.
Christian
C
Obrist
Surgical Department, Saint John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria.|Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Salzburg, Austria.
Katharina
K
Pimpl
Department of Mathematics, University of Innsbruck, Innsbruck, Austria.
Tobias
T
Hell
Surgical Department, Saint John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria. helmut.weiss@bbsalz.at.|Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Salzburg, Austria. helmut.weiss@bbsalz.at.
Helmut
H
Weiss
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome
Hepatectomy; Radiofrequency pre-coagulation; Single-incision laparoscopy