Single-incision laparoscopic liver resection

Laparoscopic liver surgery has become a safe and effective approach to the surgical management of liver disease. Recently developed, single-port-access surgery is of growing interest in an attempt to minimize abdominal wall trauma. Various abdominal procedures have already been performed via single-port access, but to date, single-port-access surgery has never been reported for liver resection. One patient underwent laparoscopic fenestration of a giant (30-cm) right hepatic cyst. Three patients underwent left liver resection through a single port for isolated liver metastasis located in segments 3/4B, 2/3, and 3/4B, respectively, and a cirrhotic patient underwent a 4B wedge resection for hepatocellular carcinoma. Each procedure was performed through a single 40-mm Gelport. No supplemental ports were required. The liver was transected using a combination of LigaSure harmonic scalpels and staplers. In one case, parenchymal transection was intraoperatively prepared by a zone of microwave ablation along the line of intended division. The total operative times for the aforementioned five patients were 140,110, 110, 120, and 55 min, respectively. The respective blood losses were 20, 50, 50, 25, and 50 ml, and the overall size of the incision was 50 mm in each case. The postoperative courses were uneventful, and each patient was discharged on postoperative day 2. This preliminary experience suggests the technical feasibility and safety of left liver wedge resection through single-port access in terms of intra- and postoperative results. Additional experiences are mandatory to assess the viability of this emerging technique and to expand its application to additional right liver resections.