Single-access transumbilical laparoscopic unroofing of a giant hepatic cyst using reusable instruments

Abstract

Introduction: Single-access laparoscopy has garnered growing interest in recent years in an attempt to improve cosmesis, reduce postoperative pain, and minimize abdominal wall trauma.

Case description: 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.

Figure 1.

Preoperative abdominal CT scan.

Figure 2.

a, 2b, and 2c. Curved reusable instruments according to DAPRI: grasping forceps III (a), coagulating hook (b), bipolar scissors (c) (courtesy of Karl Storz-Endoskope, Tuttlingen, Germany).

Figure 3.

Placement of curved instruments, scope, and purse-string suture through the umbilical incision.

Figure 4.

a and 4b. Single-access cystic roof excision (a) performed under ergonomic position (b).

Figure 5a, 5b, and 5c.

The concept of the curved instruments is based on the straight classic instruments (a) of the triangulation angle, both externally (b) and inside the abdominal cavity (c).