Feasibility Demonstration of Single Incision Multiple Port Laparoscopic Liver Resection (Simpllr) in Three Patients
Francis Cannizzo, John R. Romanelli, Ramanathan Seshadri*, Richard B. Arenas
Department of Surgery, Baystate Medical Center, Springfield, MA
Introduction: Laparoscopic liver resection has reduced morbidity and length of stay for hepatic surgery. Introduction of single incision laparoscopic surgery exploits the specimen extraction incision and may improve patient satisfaction.Methods: Three patients were selected based on the anatomy of anticipated resections to undergo single incision laparoscopic liver resections. Pt 1 is a 59yo female with a 5.5cm left lateral segment hepatocellular carcinoma. Pt 2 is a 69yo female with a 4.0cm HCC in Reidel’s lobe. Pt 3 is a 21yo female with a 2.5cm symptomatic, indeterminate left lateral segment lesion. All patients were counseled as to the risks of this procedure and the possibility of conversion to standard laparoscopic or open technique in the event of intraoperative complications. All patients gave informed consent for participation. Results: Pt 1 underwent a single incision multiport left lateral segmentectomy (EBL: 500cc, LOS: 4 days). Pathology showed a moderately differentiated HCC resected with clear margins. She is NED at 15.5 months. Pt 2 underwent adhesiolysis and resection of Reidel’s lobe using a single-port SILS™ device (Covidien, Inc) (EBL: 1700cc, LOS: 5 days). IOUS-guided parenchymal transection was completed laparoscopically. Minilaparotomy was required for specimen inspection and delivery. She received 1 unit PRBCs intraoperatively. Pathology revealed a 4cm poorly differentiated HCC abutting Glisson’s capsule. She required readmission for pain control. She is NED at 13.25 months followup. Pt 3 had a single incision multiport left lateral segmentectomy (EBL: 150cc, LOS: 2 days). Pathology showed a 2.8cm FNH abutting the capsule. She had complete resolution of her symptoms at followup.Conclusion: SIMPLLR can be a viable adjunct to laparoscopic hepatic resection for selected lesions especially in the left lateral segment and some marginal lesions. Further study and experience is needed to define the limits of this technique and its optimum applications. Prior to adoption, standard laparoscopic solid organ surgery should be mastered. A low threshold to convert to standard laparoscopic or open approach is necessary to assure patient safety and outcomes.
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