Single-incision laparoscopic surgery to treat hepatopancreatobiliary cancer: A technical review

Figure 1 The 5-mm 30° bariatric laparoscope effectively prevented “sword fighting” between the light cable (yellow arrow) of the laparoscope and the instrument handles (red arrows) in single-incision laparoscopic surgery.

Figure 2 The port configuration was arranged in a reverse triangular pattern on a commercial multichannel port in a single-incision laparoscopic surgery. The upper port served as an assistant port for additional traction or suction/irrigation.

Figure 3 The hepatoduodenal ligament was encircled by a 14-French Foley catheter (blue arrows) for temporary hepatic inflow control (Pringle maneuver) in a single-incision laparoscopic right posterior sectionectomy. An EndoGrab^TM (Virtual Ports Ltd., Hod Hasharon, Israel) provided traction in the direction of the yellow arrow, while gravity created countertraction (green arrow).

Figure 4 The curved tip of a Maryland dissector (yellow arrow) helped to form a loop made by two instruments nearly parallel to each other in a single-incision laparoscopic surgery. A monofilament thread was used in this case.

Figure 5 EndoGrab^TM (Virtual Ports Ltd. , Hod Hasharon, Israel) provided auxiliary traction during single-incision laparoscopic pancreatectomies. A: EndoGrab^TM (green arrows) was applied on the duodenal 3^rd portion to provide lateral traction (yellow arrow) during the uncinate process dissection in a single-incision laparoscopic pancreaticoduodenectomy (SILPD); B: Two EndoGrabs^TM (green arrows) facilitated upward traction (yellow arrows) of the liver edges during the reconstruction phase in a SILPD. Two pieces of gauze served as cushions to minimize the traumatic effect of EndoGrabs^TM (green arrows) on the liver.

Figure 6 Single-incision laparoscopic suturing technique was applied to a pancreatiojejunostomy. A: Three metallic clips (yellow arrows) were used at the same time during the inner duct-to-mucosa anastomosis of the pancreatiojejunostomy (PJ) in a single-incision laparoscopic pancreaticoduodenectomy; B: Completed inner duct-to-mucosa anastomosis (green arrows) of the PJ.