Laparoscopic unroofing of simple liver cyst

Anatomy Perioperative management Technique Complications Evidence Total Video

Minilaparotomy

After skin prepping and draping of the surgical field perform an infra-umbilical minilaparotomy. Insert Verres needle and establish pneumoperitoneum.
Trocar positioning

Insert one 11 mm trocar for the laparoscope and the other 11 mm trocars left laterally (working trocar for, e.g., the scissors) and in the epigastrium (working trocar for, e.g., a grasper): Insert one 5 mm trocar in right upper quadrant (working trocar, e.g. for suction).
Exploration

Expose the cyst and open it with the electrocautery scissors. Suction the cyst contents.
Tips: Depending on the thickness and quality of the cyst wall, resect it with the mono-/bipolar scissors or even the harmonic scalpel!
Perform careful hemostasis!
Deeper cysts (e.g., in polycystic liver disease) may display a blueish tinge and must be differentiated from veins: In these cases, laparoscopic ultrasound with vascular Doppler capability can be quite helpful!
Inspecting the cyst for neoplasia

Carefully inspect the cyst wall for any neoplastic changes.