title: Transgastric removal of a polycystic liver disease using mini-laparoscopic excision.
abstract: Surgical treatment is often necessary for patients with symptomatic or complicated polycystic liver diseases (PLD). In this paper, we describe a 52-year-old female with symptomatic PLD that had resulted in the formation of liver cysts, the largest of which was 23 cm in diameter. The patient underwent mini-laparoscopic fenestration through 5-mm abdominal trocars. The walls of the cysts were unroofed using a harmonic scalpel. Four thickened rubber-like pieces of specimens (sizes ranged between 9 × 6 × 0.5 cm and 6 × 3 × 0.1 cm) were not suitable for extraction through the 5-mm trocars. A gastrotomy was performed, and the specimens were extracted through the stomach with the help of an endoscope. Transoral removal of the specimens was completed without any complications, and the gastrotomy was closed intracorporeally. The patient was permitted to take fluids on day one, and oral intake was gradually increased. She was discharged on day four and was asymptomatic after two months of follow-up. The combination of mini-laparoscopy and intraoperative endoscopic specimen extraction represented a minimally invasive surgical approach for the treatment of PLD. To the best of our knowledge, this was the first case report of the transoral extraction of a liver specimen.
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Sumer
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey.
authors.forename: Yılmaz
authors.initials: Y
authors.lastname: Polat
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Ertugrul
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Karagul
keywords: endoscopy; laparoscopy; liver cyst; natural orifice specimen extraction; natural orifice surgery; transgastric removal