Laparoscopic hepatic resection of hydatid cyst using a new irrigated hook (Tissuelink)

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Laparoscopic   hepatic   resection   of   hydatid   cyst   using   a   new   irrigated   hook   (Tissuelink)

Authors
D Mutter, J Marescaux
Keywords
hepatic resection,laparoscopy,hydatid cyst,hook
Media type
Duration
07'00''
Publication
2004-04
Popular
Favorites
Favorites Media
Audio
en
Subtitles
en
E-publication
WeBSurg.com, Apr 2004;4(04).
URL: http://www.websurg.com/doi-vd01en1545e.htm

Laparoscopic   hepatic   resection   of   hydatid   cyst   using   a   new   irrigated   hook   (Tissuelink)

1. Case presentation 00'11''
This video will demonstrate hepatic resection for a hydatid cyst using the new irrigated hook, the Tissuelink device. The case is that of a 63-year-old patient with a hydatid cyst in segment VI of the liver. The patient was initially treated with percutaneous injection of hypertonic saline. The patient represented 3 years later with pain. The CT-scan reveals that there are now 2 cysts, which are active as demonstrated by positive immunoglobulin detection by Western blot and ELISA. This is a 3D virtual reality reconstruction, which was used for preoperative planning. It demonstrates the location of the tumor and the proposed resection, which will be performed. A non-anatomical hepatic resection is planned. The patient is placed in a left lateral decubitus position with optimal exposure of the surgical field. There are 2 surgeons with one scrub nurse. The trocars are placed in the position shown; one trocar for the camera, 2 for conventional instruments, and one for continuous suction. The 1st step of the procedure is the injection of hypertonic saline with suction of cyst content. Adhesions from previous inflammation are divided. The tissues around the cyst are protected using swabs in case of any spillage of cyst content or hypertonic saline. The needle with the hypertonic saline is inserted through the cyst wall with simultaneous application of suction. The hypertonic saline is applied to the cyst for 10 minutes. The shrinkage of the cyst can be observed on the bottom of the screen. The next step of the procedure is the resection of the cyst. The complexity of the surface of the cyst is appreciated here. The first cyst on the surface is de-roofed using diathermy and scissors. An Endobag is placed immediately adjacent to the area of removal of cyst wall. The resected pieces of cyst wall are carefully placed in the Endobag for removal. The wall of the 2nd cyst is very hard and cannot be easily penetrated as seen here. A pericystectomy therefore follows. This is the Tissuelink device that is used for the resection. This combines a high power diathermy hook with continuous saline irrigation. A non-anatomical resection is performed outside the wall of the cyst. The Tissuelink is used in the same way as a conventional diathermy hook. The difference is that the device uses a diathermy of high power, that is 100 Watts together with continuous irrigation, which cools the surface tissues resulting in a more even but deeper coagulation effect. On the inferior aspect of the cyst, the irrigation fluid falls away from the area of coagulation due to gravity. This is not ideal as it results in a high-powered coagulation in a dry area leading to electric sparks. Here the cauterized surface of the liver parenchyma is visible. The Tissuelink achieves a wide coagulation of the liver parenchyma as opposed to charring or black carbonization achieved by conventional diathermy. The cautery effect is 2 to 3mm thick enabling security hemostasis of small blood vessels, thus reducing the risk of secondary hemorrhage, which can occur with conventional diathermy. The dissection is continued on the other side of the cyst in the same manner. Now the cyst is completely resected. It is placed directly in the Endobag and retrieved from the body. Meticulous hemostasis is achieved using the Tissuelink. Furthermore, bipolar diathermy can be used as well as the fibrin glue. Two suction drains are placed at the end of the operation. The thick wall of the cyst can be appreciated on the resected specimen.