Inline radiofrequency pre-coagulation simplifies single-incision laparoscopic minor liver resection

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 22; no. 12; pp. 831 - 836
• Main Authors: Weiss, Michael, Mittermair, Christof, Brunner, Eberhard, Schirnhofer, Jan, Obrist, Christian, Pimpl, Katharina, Hell, Tobias, Weiss, Helmut
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01-12-2015; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Austria; Catheter Ablation - methods; Female; Hemostatic Techniques - instrumentation; Hepatectomy; Hepatectomy - methods; Humans; Laparoscopy - methods; Liver Diseases - surgery; Male; Middle Aged; Operative Time; Postoperative Complications; Prospective Studies; Radiofrequency pre-coagulation; Single-incision laparoscopy; Treatment Outcome; Radiofrequency pre-coagulation; Single-incision laparoscopy; Hepatectomy
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.295

Background
Single‐incision laparoscopy (SIL) has been developed to reduce surgical trauma, whereas technical difficulties in bleeding control limit the broad acceptance for hepatectomy. A novel minimized invasive strategy combining inline radiofrequency pre‐coagulation and transumbilical SIL is presented herein.
Methods
A cohort of 21 selected patients underwent transumbilical SIL hepatectomies (segmentectomies II–VI) utilizing inline radiofrequency pre‐coagulation for hepatic transection (Habib 4X). Bleeding control, postoperative complications and positive resection margins in malignant diseases served as primary and secondary outcome parameters, respectively.
Results
Single‐incision laparoscopy was successfully completed in all patients. A total of 33 segments were retrieved: mean resection time was 66 ± 35 min, including 11 anatomical (52.38%) and 10 non‐anatomical (47.62%) resections. Sixteen patients (76.19%) underwent concomitant abdominal surgery. No substantial blood loss occurred. Neither additional staplers nor clips were necessary to control any bleeding or bile leakage. One pleural effusion counted for the only postoperative complication. Free margins could be achieved in all but one resection (12/13 patients with malignancies; 92.31%). Ninety‐day mortality was zero.
Conclusions
The combination of SIL and inline radiofrequency pre‐coagulation proved to be a simple, efficacious and safe technique in minor hepatectomy.
Highlight
Weiss and colleagues demonstrated a novel strategy combining inline radiofrequency pre‐coagulation and single‐incision laparoscopy to allow for simple, efficacious and safe minimally invasive minor liver resection with excellent bleeding control, thus further alleviating surgical trauma. This technique has potential for broader application including major hepatic surgery via the single‐port approach.