A 45-year-old woman presented with pain and discomfort in the right lumbar region of 2 months duration, which in recent weeks prevented her from performing her usual activities.
Ultrasound diagnosed an 8 cm Ø simple liver cyst located in subsegment VI of the organ, which was confirmed by computerized axial tomography.
There was no family history of polycystic disease.
The patient refuses sclerosing treatment by percutaneous puncture, so it is proposed to perform surgical intervention with general anesthesia by traditional laparoscopic surgery or use the transvaginal approach assisted by minilaparoscopy, both techniques are offered.
With the authorization of the ethics committee of the research of the center and the informed consent of the patient was carried out the surgical intervention on May 21, 2009, performing the removal of the cyst.
The pathology report confirmed a simple cyst of the liver.
Surgical act
In both patients surgical intervention was performed using general endotracheal anesthesia, prophylactic antibiotic therapy with a single dose of cefazolin 2 g IV was applied according to the service protocol.
Modified lithotomy position, disinfection of the abdomen, vagina, perineum and proximal third of the thighs with 10% povidone-iodine and evacuation of urine with a urinary catheter.
Pneumoperitoneum with a Veres needle at a pressure of 15 mmHg, if there is a 5 mm trocar in the lower internal lobe of the patient, and through this port a pus apex 5 mm.
Under direct vision, through the vaginal sac fundus BE settles the peritoneal cavity 1 trocar of 11 mm Ø (Karl S) through which 260 SzA sealant 30 mm ØK, later on.
In patient 1, the same orifice was used to insert adjacent to the 11 mm trocar parallel to a 5 mm Ø trocar and 43 cm long (Karl Storz 33427 M colpul; in patient 2 different instruments were used.
In the abdominal wall, 1 minitrocar of 3 mm Ø was placed in both patients at the site closest to the lesion: epigastrium in patient 1 and right hypochondrium in patient 2.
In the patient with hepatic cyst, a straight needle suture was also used to insert the cyst wall percutaneously into the abdomen and exteriorly through a point near its entrance, towards the function of the rein.
In both patients, the specimens were obtained by vaginal extraction in bags.
Closure of the colpotomy was performed with two chrome catgut stitches.
A short-term analgesic (fentanyl) was used during the transoperative period and the surgical times, need for postoperative analgesics and postoperative complications were evaluated.
