Laparoscopic treatment of a hydatid cyst of the liver

This video demonstrates the surgical approach to a large hydatid cyst in the right lobe of the liver. The surgeon uses a 3D reconstruction of the liver and the cyst to create a virtual image of the diseased area and to preplan the surgical approach. The surgeon starts by performing a cholecystectomy to gain better approach to the liver cyst. Then the cyst is aspirated and hypertonic saline is inserted for twenty minutes. Through a small opening in the cyst wall the contents are aspirated. Repeat instillation of hypertonic saline helps aspirate the contents. Once completed the cyst wall is opened wider and the cavity is fully inspected. The cyst is deroofed and the anterior cyst wall removed. The edges of the liver is covered with fibrin glue and a piece of omentum is brought up and sutured to it. A drain is left in place.

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Laparoscopic   treatment   of   a   hydatid   cyst   of   the   liver

Authors
J Leroy
Abstract
This video demonstrates the surgical approach to a large hydatid cyst in the right lobe of the liver. The surgeon uses a 3D reconstruction of the liver and the cyst to create a virtual image of the diseased area and to preplan the surgical approach. The surgeon starts by performing a cholecystectomy to gain better approach to the liver cyst. Then the cyst is aspirated and hypertonic saline is inserted for twenty minutes. Through a small opening in the cyst wall the contents are aspirated. Repeat instillation of hypertonic saline helps aspirate the contents. Once completed the cyst wall is opened wider and the cavity is fully inspected. The cyst is deroofed and the anterior cyst wall removed. The edges of the liver is covered with fibrin glue and a piece of omentum is brought up and sutured to it. A drain is left in place.
Catégorie
complex cases
Mots-clés
laparoscopy,hydatid cyst,liver, preplanning, virtual reality
Type de vidéo
Durée
06'00''
Publication
2003-07
Popularité
Favoris
Favorites Media
Audio
en
Sous-titres
en
E-publication
WeBSurg.com, Jul 2003;3(07).
URL: http://www.websurg.com/doi-vd01en1443e.htm

Laparoscopic   treatment   of   a   hydatid   cyst   of   the   liver

1. Case presentation 00'14''
Because hydatid cyst of the liver continues to be endemic in many parts of the world, we present a case and treatment scenario. The patient is a 32 year-old Moroccan male who presented to us with a right upper quadrant pain and was diagnosed with liver hydatid disease. As we can see here, there are multiple adhesions of the omentum to the liver, which were lyzed with ultrasonic scissors. Due to the location of the cyst as we will see in the CT-scan, the decision was made to start with the cholecystectomy. Careful dissection of the gallbladder bed was undertaken in order to prevent opening of the cyst. The peri-hepatic artery was then carefully packed with gauzes soaked with hypertonic saline. A contrast and spiral abdominal computer tomography scan with 2mm slices demonstrated an 8 by 8 by 7cm anterior right lobe liver cyst with multiple loculations. Our software engineers have developed a method for analysis and 3D reconstructions of liver lesions as well as most intra-abdominal organs from the CT images. In this way, we can do preoperative interaction and planning. After protecting the right upper quadrant with hypertonic saline-covered sponges, a needle is introduced in the right hypochondrium to first evacuate the contents of the cyst and then inject hypertonic saline. The saline was left in place for 20 minutes. Then the ultrasonic scissors were used to open the superior aspect of the cyst. A suction cannula was available to prevent any spillage of the contents of the cyst into the abdominal cavity. Hypertonic saline was instilled again and left in place for 20 minutes. The cyst was partially opened and the contents of the cyst and scholiocysts were aspirated through a transparent cannula in which a vacuum is created with a suction device. You can see here the scoliosis being removed and the transparent trocar is introduced into the cyst cavity to evaluate the aspiration. We continue the aspiration of the cyst cavity as well as with the repetitive use of hypertonic saline as a scholiocidal agent. A 30 degree laparoscope was used to examine the cyst cavity after completion of the procedure. The solution was combined with methylene blue to facilitate the differentiation between the hypertonic saline and regular irrigant. As we can see here the effect of the scolocidal agent, you see here the hypertonic saline effect on the scolics. Now the scholiocysts can be easily aspirated. A search for secondary scolic cavities is pursued as it is not an uncommon finding with this type of disease and is the most common cause of recurrence. After the cavity has been adequately evacuated and surveyed, we will continue the final irrigation with hypertonic saline and you can see here there is no evidence of remaining disease. Partial cystectomy was then carried out using a high thermal energy device. This device was used in order to prevent bleeding and potential bile leaks. After the roof of the cyst cavity was adequately excised, then the remaining portion of the cyst cavity was opened and unroofed. We take a portion of the cyst roof and it will be placed into a plastic retrieval system in the right upper quadrant. The hypertonic saline gauzes are then placed with the specimen into the plastic retrieval system. Verification of hemostasis is undertaken and the area is evaluated for possible bile leaks. A fibrin sealant was used to complete the hemostasis in this case and because we noticed a small amount of bile staining, we felt this may help prevent a bile leak. Because a small bile stain was seen in the remaining cavity, and to fill the cavity, the omentum was retracted superiorly and placed into the cavity, and then fixed with stitches into the pseudo capsule of the cyst. The final step to the procedure, a closed suction drain left postoperatively in the left upper abdomen.