A Large Hepatic Cyst with Obstructive Jaundice Successfully Treated with Single-Incision Laparoscopic Deroofing
A 72-year-old female patient was referred to our hospital due to right upper abdominal pain. Physical examination performed on admission revealed mild tenderness in the right epigastrium. Laboratory data revealed a serum bilirubin level of 1.6 mg/dl, an aspartate aminotransferase level of 226 IU/l, an alanine aminotransferase level of 164 IU/l and an alkaline phosphate level of 1,062 IU/l. A computed tomography (CT) scan disclosed two large hepatic cysts at segment 4 measuring 86 × 112 × 115 mm (fig. ) and 39 × 45 × 40 mm (fig. ), respectively. In addition, the intrahepatic bile ducts were slightly dilated due to compression of the hepatic hilum. Magnetic resonance cholangiopancreatography (MRCP) also showed intrahepatic duct dilatation (fig. ), although no communications between the cysts and the intrahepatic bile ducts were detected. Based on these findings, the provisional diagnosis was a symptomatic large hepatic cyst with compression of the intrahepatic bile duct. The patient was scheduled to undergo laparoscopic deroofing.\nThe patient was placed in the supine position and an entry hole into the abdomen was created using an umbilical incision (25 mm). The EZ ACCESSTM oval type (Hakko Co. Ltd.; fig. ) was placed at the umbilicus using a 25-mm incision as an access port with two 5-mm trocars. An additional 12-mm port was placed at the left epigastric region (fig. ). Cysts were detected in liver segment 4. A small incision was made in the cyst using an ultrasonically activated device, and serous fluid was evacuated. A vessel sealing system (Ligasure; Covidien, Mansfield, Mass., USA) was then used to excise the cyst wall. A thick peripheral bile duct was identified and clipped.\nThe patient's postoperative course was uneventful, and she was discharged on postoperative day 8. The pathological findings revealed a solitary cyst without malignant transformation. Four months after surgery, no recurrent symptoms were observed and liver regeneration was detected on abdominal CT. The regeneration volume of the liver was 153 cm3 (fig. ).