Perioperative management - Laparoscopic unroofing of simple liver cyst

Symptomatic liver cysts: (Fatigue, breathing problems, sensation of pressure/abdominal fullness, nausea, organ displacement induced pain, icterus due to compression of the intra-/extrahepatic bile ducts).

• Solitary nonparasitic benign liver cysts
• Polycystic liver lesions type I (limited number of large cysts on hepatic surface)

• Asymptomatic cysts
• Polycystic liver lesions type II (numerous small cysts in the entire liver)
• Neoplastic cysts (cystadenoma, cystadenocarcinoma)

Relative contraindications include:

• Parasitic liver cysts
• Location: posterior liver segments I, VII, VIII
• Major coagulation disorders
• Cardiopulmonary risk factors
• Cirrhosis

Patient history and clinical examination

Abdominal CT or MRI studies

Lab studies (liver function, serum antibody screening for echinococcosis)

General risks:

• Allergy
• Thrombosis
• Embolism
• Cardiovascular reactions
• Pneumonia
• Blood transfusion
• Incisional hernia

Special risks:

• Wound infection
• Intra-abdominal infection
• Secondary bleeding
• Ascites
• Pleural effusion
• Biliary leaks
• Recurrent cyst with recurrent symptoms

General anesthesia in pneumoperitoneum

• Supine
• Arms spread
• Legs spread

• Surgeon standing between the spread legs
• Assistant right of surgeon
• Scrub nurse between surgeon and assistant

• Trocars: 2 working trocars 11 mm, 1 working trocar 5 mm, 1 trocar 11 mm for 30° laparoscope
• Mono-/bipolar scissors, possibly harmonic scalpel
• Atraumatic grasper
• Suction/irrigation unit

Postoperative analgesia:

Follow this link to PROSPECT (Procedures Specific Postoperative Pain Management).

This link will take you to the International Guideline Library.

Postoperative care:

Postoperative lab studies (Hb, Hct, bilirubin, alkaline phosphatase, CRP)

Possibly silicone drain

Deep venous thrombosis prophylaxis:

Postoperative thrombosis prophylaxis with low-molecular-weight heparin.

This link will take you to the International Guideline Library.

Ambulation:

Early – starting on day of surgery

Physical therapy:

No special physical therapy needed.

Diet:

Tea permitted a few hours after surgery, and also light food – depending on the discomfort.

Bowel movement:

Laparoscopic procedures not involving the intestines usually do not impair intestinal function; laxatives only if needed.

Work disability:

Length of hospital stay usually 3 to 5 days; work disability depends on each patient’s course.