Application of a Z-Shaped Umbilical Incision and a Saline-Cooled Radiofrequency Device to Single-Incision Laparoscopic Surgery for a Huge Liver Cyst: Report of a Case

When compared with other diseases, few authors have reported on single-incision laparoscopic surgery (SILS) for liver cysts. We herein describe our experience with SILS for a huge liver cyst with the application of an umbilical Z-shaped incision using a gel port and a high-density monopolar saline-cooled radiofrequency device with a successful outcome. An 80-old-year woman was diagnosed with a huge liver cyst with abdominal pain. She underwent percutaneous drainage of the liver cyst and injection of both absolute ethanol and an antimicrobial agent into the liver cyst at the previous hospital. Because of re-expansion of the liver cyst and symptom recurrence, we performed SILS for the liver cyst. An umbilical Z-shaped incision was made for gel port placement. After aspiration of the cystic fluid and dissection of the thin cystic wall by laparoscopic coagulating shears, the thick cystic wall was divided using an endoscopic linear stapler to avoid bleeding and bile leakage. After wide fenestration, a high-density monopolar saline-cooled radiofrequency device was applied for the ablation of the remnant membrane of the cystic wall. All maneuvers could be performed only through the gel port. The patient was discharged 4 days after surgery and was satisfied with the cosmetic results. This case shows that the application of an umbilical Z-shaped incision using a gel port and a high-density monopolar saline-cooled radiofrequency device is useful for the accomplishment of SILS for a huge liver cyst.Key words: Single-incision laparoscopic surgery, Liver cyst, Z-shaped umbilical incision, Saline-cooled radiofrequency deviceSince the laparoscopic procedure was introduced for the fenestration of a simple liver cyst in 1991,¹ laparoscopic surgery for symptomatic nonparasitic liver cysts has been recognized as a widely acceptable procedure to relieve symptoms.^2–5 In contrast, there are still few reports on single-incision laparoscopic surgery (SILS) for liver cysts.^6–10Ablation of the remnant membrane of the cystic wall is recognized as an important procedure for the prevention of recurrence.^2–5 In general, an argon beam coagulator is useful for such ablation, however, in laparoscopic surgery, intraoperative pulmonary embolism due to argon gas has been reported.^11,12We herein describe our experience with SILS for a huge liver cyst with the application of an umbilical Z-shaped incision using a gel port and a high-density monopolar saline-cooled radiofrequency device with a successful outcome.