9341GS Single Port Access (SPA) Hepatic Sling Technique Video
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Uploaded on Jul 22, 2009
TITLE: Single Port Access (SPA) Hepatic Sling Technique Video
Background: We have applied Single Port Access (SPA) surgery to procedures of the gastroesophageal (GE) junction through a single skin incision, usually placed within the umbilicus. This type of minimal access surgery requires retraction of the liver. To eliminate an externally placed liver retractor from our limited port of entry within the umbilicus, we have now developed and applied the placement of an intracorporeal Hepatic Sling consisting of a simple Penrose drain to retract the liver and maintain exposure of the GE junction.
Methods: After entry is obtained through the umbilicus using the SPA technique for the camera, 2 trocars, and one trocarless entry site, a 1-inch or ½-inch Penrose drain is inserted into the abdomen. Once the liver is retracted toward the anterior abdominal wall, the drain is secured to the diaphragm above the esophageal hiatus with a tack. The other end is passed under the left lateral lobe of the liver and tacked to the right anterior abdominal wall. A second Penrose drain may be looped around the first one in a T formation for additional support and retraction of a large lateral lobe. At the end of the procedure, the tacks are removed and slings are withdrawn.
Conclusion: The intracorporeal hepatic sling eliminates the need for an additional port site and provides a safe, effective, and applicable means to retract the liver for Single Port Access (SPA) surgical procedures involving dissection of the GE junction.
Authors: Andrew S. Wu, MD, Erica R. Podolsky, MD, Paul G. Curcillo II, MD
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