Dapri Giovanni, Dimarco Livia, Cadière Guy-Bernard, Donckier Vincent
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, 1000 Brussels, Belgium.
HPB Surg. 2012;2012:921973. doi: 10.1155/2012/921973. Epub 2012 Sep 25.
Background. Single-incision transumbilical laparoscopic liver resection (SITLLR) has been recently described in limited series. We report our experience in SITLLR and discuss the future of this approach in terms of indications, potential benefits, and limitations, with a special reference to laparoscopic liver resection (LLR). Patients and Methods. Six patients underwent SITLLR. Indications were biliary cysts (3 cases), hydatid cysts (2), and colorectal liver metastasis (1). Procedures consisted in cysts unroofing, left lateral lobectomy, pericystectomy, and wedge resection. SITLLR was performed with 11 mm reusable trocar, 10 or 5 mm 30° scopes, 10 mm ultrasound probe, curved reusable instruments, and straight disposable bipolar shears. Results. Neither conversion to open surgery nor insertion of supplementary trocars was necessary. Median laparoscopic time was 105.5 minutes and median blood loss 275 mL. Median final umbilical scar length was 1.5 cm, and median length of stay was 4 days. No early or late complications occurred. Conclusion. SITLLR remains a challenging procedure. It is feasible in highly selected patients, requiring experience in hepatobiliary and laparoscopic surgery and skills in single-incision laparoscopy. Apart from cosmetic benefit, our experience and literature review did not show significant advantages if compared with multiport LLR, underlying that specific indications remain to be established.
背景。单切口经脐腹腔镜肝切除术（SITLLR）最近在少数病例系列中有所报道。我们报告了我们在SITLLR方面的经验，并从适应症、潜在益处和局限性方面讨论了这种手术方式的未来，特别提及了腹腔镜肝切除术（LLR）。患者与方法。6例患者接受了SITLLR。适应症包括胆管囊肿（3例）、包虫囊肿（2例）和结直肠癌肝转移（1例）。手术包括囊肿开窗、左外侧叶切除术、囊肿切除术和楔形切除术。SITLLR手术使用11毫米可重复使用套管针、10或5毫米30°腹腔镜、10毫米超声探头、可弯曲的可重复使用器械以及直型一次性双极电剪。结果。无需转为开放手术，也无需插入辅助套管针。腹腔镜手术中位时间为105.5分钟，中位失血量为275毫升。脐部最终瘢痕中位长度为1.5厘米，中位住院时间为4天。未发生早期或晚期并发症。结论。SITLLR仍然是一项具有挑战性的手术。在经过严格挑选的患者中是可行的，需要具备肝胆和腹腔镜手术经验以及单切口腹腔镜技术。除了美容益处外，与多端口LLR相比，我们的经验和文献回顾并未显示出显著优势，这表明仍有待确定具体的适应症。
