Single-port Laparoscopic Left Hepatectomy

Abstract

A 45-year-old male patient was clinically diagnosed with primary liver cancer. His 45×40 mm lesion was located in Segment IV, and his serum AFP was 450 ng/ml. After careful preoperative evaluation, single-port laparoscopic left hepatectomy was performed. The step-by-step surgical procedure was listed below: (1)A simplified single-port device was made with a size 6.5 glove and a 70-70 disposable incision protective sleeve; 4/5 fingers of the glove were respectively connected to a regular trocar; the incision protective sleeve was then placed into the 3 cm paraumbilical vertical incision; pneumoperitoneum was built; and another auxiliary 12 mm trocar was placed 3 cm inferior to the costal margin along the right midclavicular line. (2) Dissect the ligamentum teres hepatis and falciform ligament, explore of the size and location of the intrahepatic lesion with intraoperative laparoscopic ultrasound; (3) Resect the gull bladder; (4) Ligate and cut the left hepatic artery, ligate the left portal vein with silk thread; (5) Dissect the liver parenchyma with ultrasound knife along the ischemic line, dealing with the branches of the middle hepatic vein carefully; (6) Endo-GIA staplers were used to ligate and split the left hepatic pedicle and left hepatic vein; (7) Bipolar coagulation forceps was used to control the bleeding of the surgical plane, and a drainage tube was placed in the right subphrenic space, and the specimen was removed. Surgical duration was 128 minutes with 300 ml blood loss. Key words: Liver Neoplasms; Laparoscopy; Hepatectomy