单孔腹腔镜左半肝切除术

患者男性，45岁，肝S4肿物45 mm×40 mm，AFP 450 ng/ml，临床诊断原发性肝癌行单孔腹腔镜左半肝切除术。手术步骤：(1)制备简易单孔通道：将6.5号手套丝线缝合固定于70 mm切口保护套，四指套各固定一个常规穿刺器；经脐3 cm直切口置入切口保护套并建立气腹；右侧锁骨中线肋缘下3 cm置入一12 mm穿刺器，辅助操作；(2)离断肝圆韧带，镰状韧带，术中超声明确肿瘤情况；(3)切除胆囊；(4)解剖第一肝门，结扎肝左动脉，门脉左支；(5)以缺血线为断肝平面，超声刀断肝，仔细处理肝中静脉分支；(6)血管闭合切割器离断左侧肝蒂及肝左静脉，移除标本；(7)双极电凝肝断面止血，膈下置引流管一条，取出标本。手术时长128 min，出血300 ml。

Single-port Laparoscopic Left Hepatectomy

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.