Minilaparoscopic-assisted transvaginal approach in benign liver lesions

Abstract

Objective: To report two benign liver lesions treatment under minilaparoscopic-assisted transvaginal approach.

Patients and methods: Females, 44 and 45 years old, respectively, were treated. Patient 1 showed a 1,2 cm Ø tumor located in the left liver lobe. In preoperative studies was not possible to discern the etiology, for what was decided surgical treatment. The patient 2 showed a symptomatic liver simple cyst, 8 cm Ø, located in the subsegment VI. She refused percutaneous treatment, it was recommended surgical treatment under general anesthesia. The surgical intervention offered was either the laparoscopic or the transvaginal approach, but this latter was accepted. Pneumoperitoneum with 15 mmHg was used. Two small trocars were inserted into the abdomen. The first one (5 mm Ø) at the umbilical region, the second one (3 mm Ø) near the lesion. One trocar 11 mm Ø, was placed in the posterior cul-de-sac. In patient 1 a large dissector was introduced adjacent to the trocar. In the patient 2, one second trocar 5 mm Ø was introduced in vagina for operative instruments. Both specimens were extracted through the vagina, protected in extractor bags.

Variables studied: operating room time; analgesia required and post-operative complications.

Results: The operating room times were 51 and 73 min, respectively. Only the patient with hepatic liver cyst required post-operative analgesia for pain at the right upper quadrant. Both patients were discharged before 24 hours. No postsurgical complications were found in the 6 months follow up.

Conclusions: Using transvaginal approach assisted with minilaparoscopy was possible to carry out surgical treatment in benign and non complex liver lesions located in outlying subsegments. It is a safe method with better aesthetic result than laparoscopic surgery. Nevertheless, will be necessary future studies that demonstrate the advantages of this approach in the hepatic lesions.