%0 Journal Article
%T Initial Experience in Single-Incision Transumbilical Laparoscopic Liver Resection: Indications, Potential Benefits, and Limitations
%A Giovanni Dapri
%A Livia DiMarco
%A Guy-Bernard Cadi¨¨re
%A Vincent Donckier
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/921973
%X 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¡ã 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. 1. Introduction Since the first reports in the nineteen¡¯s [1, 2], laparoscopic liver resection (LLR) has now become a well-recognized and accepted procedure for treatment of liver tumors in selected cases. Currently, feasibility, safety, and clinical benefits of LLR have been clearly demonstrated for treatment of both benign [3] and malignant liver tumors [4]. Initially, LLR have been reserved to small lesions, located in anterior liver segments, at distance of major vascular and biliary structures, but, now, the feasibility and safety of LLR for tumors located posteriorly, centrally or requiring a major hepatic resection have been established [5]. A step forward, laparoscopic living donor hepatectomy, including left lobectomy for liver transplantation in children [6] and right hepatectomy for adult liver transplantation, has been proposed by specialized groups [7]. Single-incision transumbilical laparoscopy (SITL), firstly performed in 1992 [8], recently gained interest in general surgery. SITL represents the latest advance of the laparoscopic approach, aiming mainly to improve the cosmetic outcomes, while other potential advantages such
%U http://www.hindawi.com/journals/hpb/2012/921973/