• Hepatocellular carcinoma
• Laparoscopic liver surgery
• Liver resection
• Multiport laparoscopic liver resection
• Single incision

• Hepatocellular carcinoma
• Minimally invasive surgery
• Recurrence

• NOTES
• SILS
• laparoscopic surgery
• liver surgery
• minimally invasive

Laparoscopic left lateral sectionectomy (LLLS) is a feasible and safe procedure with a relatively smooth learning curve. However, single-incision LLLS requires extensive surgical experience and advanced techniques. The aim of this study is to report the standardized single-incision plus one-port LLLS (reduced port LLLS, RPLLLS) technique and evaluate its safety, feasibility, and effectiveness for junior surgeons.

Between January 2008 and November 2020, the clinical records of 49 patients who underwent LLLS, divided into the conventional LLLS (n = 37) and the RPLLLS group (n = 12), were retrospectively reviewed. The patient characteristics, pathologic results, and operative outcomes were evaluated.

A history of previous abdominal surgery in the RPLLLS group was significantly high (56.8% vs. 91.7%, p = 0.552). Notably, junior surgeons performed 62.2% of the conventional LLLSs and 58.4% of the standardized RPLLLSs. There were no significant differences between the two groups in terms of median operative time (121.0 vs. 113.5, p = 0.387), median blood loss (13.0 vs. 8.5, p = 0.518), median length of hospital stays (7.0 vs. 7.0, p = 0.408), and morbidity rate (2.7% vs. 0%, p = 0.565), respectively.

This standardized RPLLLS is a feasible and safe alternative to conventional LLLS and may become the ideal training procedure for both junior surgeons and surgeons aiming to learn more complex procedures.

• Hepatectomy
• Laparoscopic
• Left lateral sectionectomy
• Liver resection
• Reduced port
• Training

• Laparoscopic
• Liver resection
• Malignant tumors
• Minimally invasive
• Single incision

• Laparoendoscopic single site
• Liver resection
• Oncological outcome
• Single-port

• Aged
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Hepatitis B, Chronic/complications
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Length of Stay
• Liver Cirrhosis/complications
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Male
• Margins of Excision
• Middle Aged
• Operative Time
• Postoperative Complications/etiology
• Postoperative Period
• Retrospective Studies
• Treatment Outcome

• Biomarkers/blood
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic
• Female
• Hepatectomy
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Liver Transplantation
• Male
• Middle Aged
• Necrosis
• Retrospective Studies
• alpha-Fetoproteins/analysis

• Hepatectomy
• Hepatocellular carcinoma
• Laparoscopy
• Living donor

To evaluate the clinical advantages of single-port laparoscopic hepatectomy (SPLH) compare to multi-port laparoscopic hepatectomy (MPLH).

We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated.

Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH (P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group (P = 0.962). Mean operative time was 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group (P < 0.001). The amount of blood loss was 385.1 ± 409.3 mL in the SPLH group and 559.9 ± 624.9 mL in the MPLH group (P = 0.016). The safety resection margin did not show a significant difference (0.84 ± 0.84 cm in SPLH vs 1.04 ± 1.22 cm in MPLH, P = 0.704). Enteral feeding was started earlier in the SPLH group (1.06 ± 0.27 d after operation) than in the MPLH group (1.63 ± 1.27 d) (P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group (7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different (P = 0.397) and there was no major perioperative complication or mortality case in both groups.

Single-port laparoscopic liver surgery seems to be a feasible approach for various kinds of liver diseases.

• Hepatectomy
• Laparoscopy
• Minimally invasive surgery
• Treatment outcome
• Feasibility study

• Adult
• Aged
• Blood Loss, Surgical/statistics & numerical data
• Blood Transfusion/statistics & numerical data
• Conversion to Open Surgery/statistics & numerical data
• Feasibility Studies
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Length of Stay/statistics & numerical data
• Liver Diseases/surgery
• Male
• Margins of Excision
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Retrospective Studies
• Treatment Outcome

• hepatobiliary surgery
• liver surgery
• minimally invasive liver surgery
• multiport laparoscopic liver surgery, MILL
• single-incision laparoscopic liver surgery, SILL

The liver is a vascular-rich solid organ. Safe and effective dissection of the vessels and liver parenchyma, and control of intraoperative bleeding are the main concerns when performing liver resection. Several studies have confirmed that intraoperative blood loss and postoperative transfusion are predictors of postoperative morbidity and mortality in liver surgery. Various methods and instruments have been developed during hepatectomy. Stapling devices are crucial for safe and rapid anastomosis. They are used to divide hepatic veins and portal branches, and to transect liver parenchyma in open liver resection. In recent years, laparoscopic liver surgery has developed rapidly, and is now preferred by many surgeons. Stapling devices have also been gradually introduced in laparoscopic liver surgery, from dividing vascular and biliary structures to parenchymal transection. This may be because staplers make manipulation more simple, rapid and safe. Even in single incision laparoscopic surgery, which is recognized as a new minimally invasive technique, staplers are also utilized, especially in left lateral hepatectomy. For safe application of stapling devices in liver surgery, more related designs and modifications, such as application of a suitable laparoscopic articulating liver tissue crushing device, a staple line reinforcement technique with the absorbable polymer membrane or radiofrequency ablation assistance, are still needed. More randomized studies are needed to demonstrate the benefits and find broader indications for the use of stapling devices, to help expand their application in liver surgery.

• Staplers
• Liver resection
• Laparoscopy

• Hepatectomy/instrumentation
• Humans
• Laparoscopy
• Surgical Stapling/instrumentation

• Laparoscopic liver resection
• Minimal invasive liver surgery
• Single-port laparoscopic liver resection
• Single-port laparoscopic surgery

• Cancer
• Laparoscopy
• Liver
• Minimal invasive
• Single port

Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL) procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome.

Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review.

Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL). The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good.

Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.

• single incision laparoscopic hepatectomy
• single-port laparoscopic liver resection
• single-site laparoscopic liver resection

Single-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease.

Between October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group.

The body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 ± 39.9 and 95.9 ± 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 ± 301.3 and 322.5 ± 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 ± 300.7 and 362.3 ± 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 ± 2.5 and 7.3 ± 5.2 days respectively (P = 0.140).

Single-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery.

• Laparoscopy
• Splenectomy

• Laparoscopic liver resection
• reduced port surgery
• single incision laparoscopic surgery

• Equipment Design
• Hepatectomy/methods
• Humans
• Laparoscopes
• Laparoscopy/methods
• Liver Neoplasms/surgery

Emerging concepts of “reduced port surgery” have gained considerable attention from laparoscopic surgeons, including the field of liver resection. To date, 86 cases of single-incision laparoscopic hepatectomy (SILH) have been reported, with commercially available access devices being used in most of these cases. We report herein a use of homemade transumbilical glove port for SILH.

A 39-year-old woman represented giant hepatic hemangioma (9-cm in size) located at the left lateral segment (S2/3). Partial hepatectomy was performed by the glove method via single port access with conventional laparoscopic bipolar forceps, grasper and scissors without the need of any single-port specific devices.

The operative time was 77 minutes, and intraoperative blood loss was 50 mL. The postoperative course was uneventful.

Glove method not only has significant advantages in terms of cost, but also is superior in its versatility, allowing wider range of movements compared to conventional access devices. Taking in consideration its cost effectiveness and versatility, glove method may be a good option for SILH.

• Glove method
• single-incision laparoscopic hepatectomy

Single incision laparoscopy (SIL) has become an emerging technology aiming at a further reduction of abdominal wall trauma in minimally invasive surgery. Available data is encouraging for the safe application of standardized SIL in a wide range of procedures in gastroenterology and hepatology. Compared to technically simple SIL procedures, the merit of SIL in advanced surgeries, such as liver or colorectal interventions, compared to conventional laparsocopy is self-evident without any doubt. SIL has already passed the learning curve and is routinely utilized in expert centers. This minimized approach has allowed to enter a new era of surgical management that can not be acceded without a fruitful combination of prudent training, consistent day-to-day work and enthusiastic motivation for technical innovations. Both, basic and novel technical specifics as well as particular procedures are described herein. The focus is on the most important surgical interventions in gastroenterology and aims at reviewing the current literature and shares our experience in a high volume center.

• Minimal invasive surgery
• Single port surgery
• Single incision laparoscopy
• Gastroenterology
• Hepatology

• Clinical Competence
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/classification
• Digestive System Surgical Procedures/instrumentation
• Digestive System Surgical Procedures/methods
• Equipment Design
• Humans
• Laparoscopes
• Laparoscopy/adverse effects
• Laparoscopy/classification
• Laparoscopy/instrumentation
• Laparoscopy/methods
• Learning Curve
• Patient Selection
• Risk Factors
• Terminology as Topic
• Treatment Outcome

• Robotics
• hepatectomy
• minimally invasive surgery

• Cirugía hepática laparoscópica
• Cirugía hepática por incisión única
• Cirugía por puerto único
• Laparoscopic liver resection
• Single-port access surgery
• Single-port laparoscopic hepatectomy

• Adult
• Aged
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/surgery
• Clinical Competence/statistics & numerical data
• Female
• Hepatectomy/economics
• Hepatectomy/mortality
• Hepatectomy/statistics & numerical data
• Hospital Costs
• Hospitals, High-Volume/statistics & numerical data
• Hospitals, Low-Volume/statistics & numerical data
• Humans
• Length of Stay
• Liver Neoplasms/mortality
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Propensity Score
• Retrospective Studies
• Survival Rate
• Taiwan
• Treatment Outcome

Liver resection for hepatocellular carcinoma (HCC) is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis. The aim of this review is to assess current indications, advantages and limits of laparoscopic surgery for HCC resections. We also discussed the possible evolution of this surgical approach in parallel with new technologies.

• Hepatocellular carcinoma
• Laparoscopic liver resection
• Hepatectomy
• Minimally invasive
• Review
• Laparoscopic resection of gastrointestinal

• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Diffusion of Innovation
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Postoperative Complications/etiology
• Risk Factors
• Treatment Outcome

• Hepatectomy
• laparoscopy
• single incision

Robotic liver surgery was found to offer advantages not inherent in conventional laparoscopic liver resection.

Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery.

A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated.

A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21–68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10–200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered.

Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.

• Adult
• Aged
• Feasibility Studies
• Female
• Genital Neoplasms, Female/surgery
• Gynecologic Surgical Procedures/methods
• Humans
• Hysterectomy/methods
• Length of Stay
• Lymph Node Excision/methods
• Middle Aged
• Ovariectomy/methods
• Postoperative Complications/epidemiology
• Salpingectomy/methods

Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.

• Laparoscopic liver resection
• Laparoscopic hepatectomy
• Minimally invasive liver surgery
• Hand-assisted technique
• Hybrid technique