Skip to main content
SpringerLink
Log in

Laparoendoscopic single-site liver resection: a preliminary report of 12 cases

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoendoscopic single-site (LESS) surgery is an emerging laparoscopic procedure previously used for cholecystectomy and appendectomy. However, few studies have examined LESS liver resection, and its benefits require investigation. This study aimed to evaluate the feasibility and safety of LESS liver resection.

Methods

From December 2009 to October 2010, 12 patients were selected for LESS liver resection with institutional review board approval. The LESS technique was performed using a transumbilical TriPort or three 5-mm trocars with a 5-mm linear or flexible laparoscope. Conventional or articulating laparoscopic instruments were used to mobilize and transect the lesions.

Results

The LESS liver resection procedure was successfully completed for 10 patients (83.3%), with the remaining 2 patients (16.7%) undergoing conversion to conventional multiport laparoscopy. The procedures consisted of left lateral segment resection (n = 4) and partial resection (n = 8) in addition to concomitant cholecystectomy (n = 3). The mean operative time was 80.4 min (range, 35–160 min), and the mean estimated blood loss was 45 ml (range, 20–800 min). No postoperative complications were noted except for biliary leakage (200 ml/day)in one patient. The mean hospital stay was 4.3 days (range, 2–8 days). No patient required postoperative analgesia, and the pain visual analog score 48 h after surgery was 0.53 (range, 0–2). Pathology identified 10 benign and 2 malignant liver tumors with a clear margin.

Conclusions

Our preliminary data show that LESS liver resection is safe and feasible for selected patients, with potential benefits that include a fast recovery, light pain, and cosmetically acceptable scarring. However, this procedure requires advanced instruments and complicated laparoscopic techniques, with a risk of intraoperative bleeding and postoperative bile leakage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sodergren MH, Clark J, Athanasiou T, Teare J, Yang GZ, Darzi A (2009) Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice. Surg Endosc 23:680–687

    Article  PubMed  Google Scholar 

  2. Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 55:1198–1204

    Article  PubMed  Google Scholar 

  3. Binenbaum SJ, Teixeira JA, Forrester GJ, Harvey EJ, Afthinos J, Kim GJ, Koshy N, McGinty J, Belsley SJ, Todd GJ (2009) Single-incision laparoscopic cholecystectomy using a flexible endoscope. Arch Surg 144:734–738

    Article  PubMed  Google Scholar 

  4. Hodgett SE, Hernandez JM, Morton CA, Ross SB, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192

    Article  PubMed  Google Scholar 

  5. Hong TH, Kim HL, Lee YS, Kim JJ, Lee KH, You YK, Oh SJ, Park SM (2009) Transumbilical single-port laparoscopic appendectomy (TUSPLA): scarless intracorporeal appendectomy. J Laparoendosc Adv Surg Tech A 19:75–78

    Article  PubMed  Google Scholar 

  6. Fagotti A, Fanfani F, Marocco F, Rossitto C, Gallotta V, Scambia G (2009) Laparoendoscopic single-site surgery (LESS) for ovarian cyst enucleation: report of first 3 cases. Fertil Steril 92(1168):e13–e16

    PubMed  Google Scholar 

  7. Fader AN, Escobar PF (2009) Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol 114:157–161

    Article  PubMed  Google Scholar 

  8. Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, Desai MR, Rao PP, Sotelo R, Stein R, Gill IS (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74:805–812

    Article  PubMed  Google Scholar 

  9. Teixeira J, McGill K, Binenbaum S, Forrester G (2009) Laparoscopic single-site surgery for placement of an adjustable gastric band: initial experience. Surg Endosc 23:1409–1414

    Article  PubMed  CAS  Google Scholar 

  10. Barbaros U, Dinccag A (2009) Single-incision laparoscopic splenectomy: the first two cases. J Gastrointest Surg 13:1520–1523

    Article  PubMed  Google Scholar 

  11. Bucher P, Pugin F, Morel P (2008) Single-port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016

    Article  PubMed  Google Scholar 

  12. Leroy J, Cahill RA, Asakuma M, Dallemagne B, Marescaux J (2009) Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173–179; discussion 179

    Article  PubMed  Google Scholar 

  13. Kaouk JH, Goel RK (2009) Single-port laparoscopic and robotic partial nephrectomy. Eur Urol 55:1163–1169

    Article  PubMed  Google Scholar 

  14. Mantke R, Wicht S (2010) Single-port liver cyst fenestration combined with single-port laparoscopic cholecystectomy using completely reusable instruments. Surg Laparosc Endosc Percutan Tech 20:e28–e30

    Article  PubMed  Google Scholar 

  15. Patel AG, Belgaumkar AP, James J, Singh UP, Carswell KA, Murgatroyd B (2011) Single-incision laparoscopic left lateral sectionectomy of colorectal liver metastasis. Surg Endosc 25:649–650

    Article  PubMed  Google Scholar 

  16. Aldrighetti L, Guzzetti E, Ferla G (2011) Laparoscopic hepatic left lateral sectionectomy using the laparoendoscopic single site approach: evolution of minimally invasive liver surgery. J Hepatobiliary Pancreat Sci 18:103–105

    Article  PubMed  Google Scholar 

  17. Gaujoux S, Kingham TP, Jarnagin WR, D’Angelica MI, Allen PJ, Fong Y (2011) Single-incision laparoscopic liver resection. Surg Endosc 25:1489–1494

    Article  PubMed  Google Scholar 

  18. Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–389

    Article  PubMed  Google Scholar 

  19. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 250:825–830

    Article  PubMed  Google Scholar 

  20. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection: 2,804 patients. Ann Surg 250:831–841

    Article  PubMed  Google Scholar 

  21. Abu Hilal M, McPhail MJ, Zeidan B, Zeidan S, Hallam MJ, Armstrong T, Primrose JN, Pearce NW (2008) Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol 34:1285–1288

    Article  PubMed  CAS  Google Scholar 

  22. Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486

    PubMed  Google Scholar 

  23. Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427

    Article  PubMed  Google Scholar 

  24. Langwieler TE, Nimme T, Back M (2009) Single-port access in laparoscopic cholecystectomy. Surg Endosc 23:1138–1141

    Article  PubMed  Google Scholar 

  25. Raman JD, Scott DJ, Cadeddu JA (2009) Role of magnetic anchors during laparoendoscopic single-site surgery and NOTES. J Endourol 23:781–786

    Article  PubMed  Google Scholar 

  26. Dominguez G, Durand L, De-Rosa J, Danguise E, Arozamena C, Ferraina PA (2009) Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 23:1660–1666

    Article  PubMed  Google Scholar 

  27. Desai MM, Stein R, Rao P, Canes D, Aron M, Rao PP, Haber GP, Fergany A, Kaouk J, Gill IS (2009) Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology 73:182–187

    Article  PubMed  Google Scholar 

  28. Aron M, Canes D, Desai MM, Haber GP, Kaouk JH, Gill IS (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103:516–521

    Article  PubMed  Google Scholar 

  29. Kaouk JH, Goel RK, Haber GP, Crouzet S, Stein RJ (2009) Robotic single-port transumbilical surgery in humans: initial report. BJU Int 103:366–369

    Article  PubMed  Google Scholar 

  30. Targarona EM, Pallares JL, Balague C, Luppi CR, Marinello F, Hernández P, Martínez C, Trias M (2010) Single-incision approach for splenic diseases: a preliminary report on a series of 8 cases. Surg Endosc 24:2236–2240

    Article  PubMed  Google Scholar 

  31. Rane A, Ahmed S, Kommu SS, Anderson CJ, Rimington PD (2009) Single-port “scarless” laparoscopic nephrectomies: the United Kingdom experience. BJU Int 104:230–233

    Article  PubMed  Google Scholar 

  32. Connor S (2009) Single-port-access cholecystectomy: history should not be allowed to repeat. World J Surg 33:1020–1021

    Article  PubMed  Google Scholar 

  33. Prasad A (2010) Single-incision laparoscopic surgery. World J Gastroenterol 16:2705–2706

    Article  PubMed  Google Scholar 

  34. Vanagas T, Gulbinas A, Pundzius J, Barauskas G (2010) Radiofrequency ablation of liver tumors (II): clinical application and outcomes. Medicina Kaunas 46:81–88

    PubMed  Google Scholar 

  35. Asahina Y, Nakanishi H, Izumi N (2009) Laparoscopic radiofrequency ablation for hepatocellular carcinoma. Dig Endosc 21:67–72

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Medjaden Bioscience Limited and Professor Duo Li from Aerospace Central Hospital for their valuable language assistance in the preparation of the manuscript.This work was not supported by any outside research funding.

Disclosures

Guodong Zhao, Minggen Hu, Rong Liu, Dabin Xu, Caiguo Ouyang, Yong Xu, Huabo Jiao, Baofu Wang, Xin Gu have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, 28 Fu Xing Road, Beijing, 100853, China

    Guodong Zhao, Minggen Hu, Rong Liu, Baofu Wang & Xin Gu

  2. Department of Hepatobiliary Surgery, Aerospace Central Hospital, Beijing, China

    Dabin Xu & Caiguo Ouyang

  3. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China

    Yong Xu & Huabo Jiao

Authors
  1. Guodong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Minggen Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dabin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caiguo Ouyang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Huabo Jiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Baofu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xin Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rong Liu.

Additional information

Guodong Zhao and Minggen Hu contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhao, G., Hu, M., Liu, R. et al. Laparoendoscopic single-site liver resection: a preliminary report of 12 cases. Surg Endosc 25, 3286–3293 (2011). https://doi.org/10.1007/s00464-011-1706-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1706-1

Keywords

Search

Navigation