Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017:39:328-331.
doi: 10.1016/j.ijscr.2017.08.053. Epub 2017 Sep 1.

Scarless surgery for a huge liver cyst: A case report

Hiroyuki Kashiwagi  1 , Jun Kawachi  2 , Naoko Isogai  2 , Masanori Ishii  3 , Katsunori Miyake  2 , Rai Shimoyama  2 , Ryota Fukai  2 , Hidemitsu Ogino  2
Affiliations

Scarless surgery for a huge liver cyst: A case report

Hiroyuki Kashiwagi et al. Int J Surg Case Rep. 2017.

Abstract

Introduction: Symptomatic or complicated liver cysts sometimes require surgical intervention and laparoscopic fenestration is the definitive treatment for these cysts. We performed minimally invasive surgery, hybrid natural orifice transluminal endoscopic surgery (NOTES) without scarring, for a huge liver cyst.

Presentation of case: An 82-year-old female presented with a month-long history of right upper abdominal pain. We diagnosed her condition as a huge liver cyst by morphological studies. She denied any history of abdominal trauma. Her serum CEA and CA19-9 were normal and a serum echinococcus serologic test was negative. Laparoscopic fenestration, using a hybrid NOTES procedure via a transvaginal approach, was performed for a huge liver cyst because we anticipated difficulty with an umbilical approach, such as single incision laparoscopic surgery (SILS). Her post-operative course was uneventful and she was discharged from our hospital three days after surgery. Pain killers were not required during and after hospitalization. No recurrence of the liver cyst or bulging was detected by clinical examination two years later.

Discussion: A recent trend of laparoscopic procedure has been towards minimizing the number of incisions to achieve less invasiveness. This hybrid NOTES, with a small incision for abdominal access, along with vaginal access, enabled painless operation for a huge liver cyst.

Conclusion: We report a huge liver cyst treated by hybrid NOTES. This approach is safe, less invasive, and may be the first choice for a huge liver cyst.

Keywords: Hybrid NOTES; Liver cyst; Scarless surgery; Wide fenestration.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
A CT scan shows a well-demarcated water attenuation of the liver. Partial wall thickening or septum was not seen. The cyst compresses the neighboring organs, such as the right side of the kidney and right atrium.
Fig. 2
Fig. 2
The 2nd port is inserted into the posterior of the vagina.
Fig. 3
Fig. 3
Intra-operative findings of fenestration. A harmonic scalpel was used to cut the cyst wall.
Fig. 4
Fig. 4
A CT scan demonstrates no recurrence of the liver cyst two years later.
Fig. 5
Fig. 5
Surgical wounds after surgery show the minimal incisions. Only 5 and 2 mm scars are present (⇒).
See this image and copyright information in PMC

References

    1. Fiamingo P., Tedeschi U., Veroux M., Cillo U., Brolese A., Da Rold A., Madia C., Zanus G., D'Amico D.F. Laparoscopic treatment of simple hepatic cysts and polycystic liver disease. Surg. Endosc. 2003;17(4):623–626. - PubMed
    1. Gigot J.F., Legrand M., Hubens G., de Canniere L., Wibin E., Deweer F., Druart M.L., Bertrand C., Devriendt H., Droissart R., Tugilimana M., Hauters P., Vereecken L. Laparoscopic treatment of nonparasitic liver cysts: adequate selection of patients and surgical technique. World J. Surg. 1996;20(5):556–561. - PubMed
    1. Kashiwagi H., Kumagai K., Nozue M. Single incision laparoscopic surgery for a life-threatening, cyst of liver. Tokai J. Exp. Clin. Med. 2011;36(1):13–16. - PubMed
    1. Agha R.A., Fowler A.J., Saeta A., Barai I., Rajmohan S., Orgill D.P., Group S. The SCARE statement: consensus-based surgical case report guidelines. Int. J. Surg. 2016;34:180–186. - PubMed
    1. Oda M., Shiihara R., Ohmae Y., Kabura M., Takagishi T., Kobayashi K., Nagahama M., Inoue M., Abe T., Setsu K., Sakurai J. Clostridium perfringens alpha-toxin induces the release of IL-8 through a dual pathway via TrkA in A549 cells. Biochim. Biophys. Acta. 2012;1822(10):1581–1589. - PubMed