Laparoscopic unroofing of simple liver cyst

  1. Minilaparotomy


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

  2. Trocar positioning

    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).

  3. 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!

  4. Inspecting the cyst for neoplasia

    Inspecting the cyst for neoplasia

    Carefully inspect the cyst wall for any neoplastic changes.

Circular resection of cyst wall

Unroof the cyst by circular resection along the cyst margin with the monopolar scissors. ... - Oper

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