Single Skin Incision (SPA) Hepatic Sling Insertion

Introduction: A Single Port Access (SPA) can be used in the surgery of the the gastroesophagal (GE) junction via single skin incision, made most often in the umbilical region. To apply this method, the liver should be withdrawn. Because the insertion of the external retractor through the umbilicus revealed to be difficult, we have proposed the use of a Hepatic Sling device. This technique requires Penrose drain, which serves to the liver withdrawal and provides view of the GE connection. Methods: First, a camera, two trocars and Penrose drain are placed in the abdominal cavity. Then, the liver is withdrawed to the anterior wall of the abdomen, the adhesion of the drain to the diaphragm is provided. The other part of the drain, after passing under the left lateral liver lobe, is sutured to the right anterior wall of the abdomen. When the more effective withdrawal due to a big lobe is needed, another Penrose drain is used (T form structure thanks to loop creation). Before ending the intervention, tacks and slings are taken out ofthe abdomen. Conclusion: The use of intracorporeal hepatic sling prevents from another skin incision and is a good, secure and valuable method of liver withdrawal in a Single Port Access (SPA) interventions, during which the GE junction exposure is needed. Authors: Andrew S. Wu, MD, Erica R. Podolsky, MD, Paul G. Curcillo II, MD