Therapeutic advances: Single incision laparoscopic hepatopancreatobiliary surgery

Abstract

Single-port laparoscopic surgery (SPLS) is proposed to be a step towards minimizing the invasiveness of surgery, and has since gained popularity in several surgical sub-specialties including hepatopancreatobiliary surgery. SPLS has since been applied to cholecystectomy, liver resection as well as pancreatectomy for a multitude of pathologies. Benefits of SPLS over conventional multi-incision laparoscopic surgery include improved cosmesis and potentially post-operative pain at specific time periods and extra-umbilical sites. However, it is also associated with longer operating time, increased rate of complications, and increased rate of port-site hernia. There is no significant difference between length of hospital stay. SPLS has a significant learning curve that affects operating time, rate of conversion and rate of complications. In this article, we review the literature on SPLS in hepatobiliary surgery - cholecystectomy, hepatectomy and pancreatectomy, and offer tips on overcoming potential technical obstacles and minimizing the complications when performing SPLS - surgeon position, position of port and instruments, instrument crossing position, standard hand grip vs reverse hand grip, snooker cue guide position, prevention of incisional hernia. SPLS is a promising direction in laparoscopic surgery, and we recommend step-wise progression of applications of SPLS to various hepatopancreatobiliary surgeries to ensure safe adoption of the surgical technique.

Keywords: Single port laparoscopic; Cholecystectomy; Hepatectomy; Pancreatectomy; Liver resection

Core tip: This manuscript is an up-to-date review of the recent developments in single port laparoscopic hepatopancreatobiliary surgeries. A comprehensive review of all meta-analyses published on the topic of single port laparoscopic cholecystectomy will be discussed as well as a summary of the published literature of the application of single port laparoscopic surgery in liver and pancreatic surgeries will be presented. The author who has a personal experience of more than 350 single port laparoscopic hepatopancreatobiliary surgeries will offer a detailed description of his technique and tips on how to avoid the pitfalls as well as adopting the technique easily.