Laparoscopic unroofing of simple liver cyst

Anatomy Perioperative management Technique Complications Evidence Total Video

Minilaparotomy

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After skin prepping and draping of the surgical field perform an infra-umbilical minilaparotomy. Insert Verres needle and establish pneumoperitoneum.
Trocar positioning

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Insert one 11 mm trocar for the laparoscope and the other 11 mm trocars left laterally (working trocar for, e.g., the scissors) and in the epigastrium (working trocar for, e.g., a grasper): Insert one 5 mm trocar in right upper quadrant (working trocar, e.g. for suction).
Exploration

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Expose the cyst and open it with the electrocautery scissors. Suction the cyst contents.
Tips: Depending on the thickness and quality of the cyst wall, resect it with the mono-/bipolar scissors or even the harmonic scalpel!
Perform careful hemostasis!
Deeper cysts (e.g., in polycystic liver disease) may display a blueish tinge and must be differentiated from veins: In these cases, laparoscopic ultrasound with vascular Doppler capability can be quite helpful!
Inspecting the cyst for neoplasia

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Carefully inspect the cyst wall for any neoplastic changes.