An 81-year old male patient, surnamed Wang, developed severe abdominal distension recently, and his appetite was also worsened. He had medical history of liver cysts, which were significantly enlarged and compressed the stomach, leading to unbearable abdominal distension, inability to eat normally and imposing evident oppression to surrounding organs. This condition severely threatened his life. The elderly patient was in the rehabilitation of cerebral hemorrhage complicated with different primary diseases such as type I respiratory failure, coronary heart disease, pericardial effusion and hypertension, etc. The patient and his family have visited many hospitals, but received no effective treatment.
After explicit inquiries, his family members consulted outpatient clinic of Professor Lyu Yi from Department of Hepatobiliary Surgery in the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU) for medical treatment. Professor Lyu Yi explicitly inquired about medical history and analyzed the imaging findings. After comprehensive evaluation, the patient was admitted to FAH. In the hospitalization certificate, "MDT (Multidisciplinary Team)" and "single-port laparoscopic fenestration and drainage of liver cysts" were indicated. Both the patient and his family were relieved after hearing that the disease can be cured by minimally invasive surgery.
Immediately after admission, Professor Zhang Xiaogang organized MDT discussions among departments of Cardiovascular medicine, respiratory medicine, anesthesiology and Surgical DreamWorks to evaluate the patients' cardiopulmonary function and make perioperative plans. Head nurse Tian Boyan led the nursing team to make detailed and standardized arrangements for perioperative nursing status, laying a solid foundation for surgical success and postoperative rehabilitation.
Based on profound technical accumulation in the early stage of Surgical DreamWorks, Professor Lyu Yi suggested using dual-wavelength laser (980 nm/1470 nm) and flexible single-port laparoscope for fenestration and drainage of hepatic cysts. This minimally invasive surgery has advantages of less trauma and bleeding, less postoperative pain, faster recovery and better concealment of postoperative incision. After comprehensive preoperative evaluation and full preparation, on September 24, Professor Zhang Xiaogang's team successfully performed laser-assisted fenestration and drainage of liver cysts under single-port laparoscope. The incision size was only 2 cm, and intraoperative bleeding was extremely small. At postoperative 2 days, the patient could walk, his abdominal distension was alleviated, and complained no discomfort after eating. He was discharged from hospital after rapid recovery.
Single-port laparoscopy has advantages of slight trauma and convenient operating field, and surgical procedures can be performed in a single operating port. Dual-wavelength laser has high cutting efficiency and excellent hemostatic effect. These two techniques complement each other and guarantee the success of surgery. According to literature review, this is the first case of single-port laparoscopic laser-assisted fenestration and drainage of hepatic cysts in China. It can not only ensure the safety and success of surgery, but also bring physical and psychological comforts to the patient, supplementing novel ideas for minimally invasive surgery.
