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Transumbilical single-incision laparoscopic fundoplication: a new technique for liver retraction using cyanoacrylate
Ying Fan1, Shuo-Dong Wu, Jing Kong
1Department of Minimally Invasive Surgery, Sheng Jing Hospital of China Medical University, Shenyang City, Liaoning Province, People’s Republic of China.
Background/Aim:
Single-incision laparoscopic fundoplication is not widespread because of its technical difficulty. An additional stay suture or retractor is often needed for liver retraction during the procedure. Here, we share our 7 cases to demonstrate the feasibility of transumbilical single-incision laparoscopic fundoplication with a new technique for liver retraction without any stay suture or retractor.
Patients And Methods:
From March 2010 to October 2011, 3 patients with achalasia underwent a transumbilical single-incision laparoscopic Heller-Dor operation, and 4 patients with hiatus hernia underwent transumbilical single-incision laparoscopic hernioplasty and Nissen fundoplication. The procedures were attempted transumbilically by using three rigid trocars (one was 10 mm, and two were 5 mm) inserted through the 2-cm umbilicus incision. Conventional laparoscopic instruments were used. Adequate retraction of the liver was achieved by binding the lateral left lobe of the liver to the diaphragm with cyanoacrylate.
Results:
The pneumoperitoneal time was 115-170 minutes, and blood loss was 15-50 mL. There were no intra- or postoperative complications. The hospital stay was under 6 days for all patients. The umbilical incision healed well with satisfactory cosmetic effect.
Conclusions:
The transumbilical single-incision laparoscopic technique in the treatment of achalaisa and hiatus hernia is feasible for an experienced laparoscope surgeon with excellent cosmetic effect. Cyanoacrylate, when used as described, offers a safe and simple solution to the problem of liver retraction, thus obviating the need for a stay suture or liver retractor.
