Safe Laparoscopic Treatment of a Giant Hepatic Cyst That Compressed the Inferior Vena Cava With Severe Kyphosis

Abstract

We report a case in which a giant hepatic cyst located at the hepatic hilum and compressing the inferior vena cava was safely treated laparoscopically with careful attention to hemodynamics in a difficult fenestrated resection in a patient with severe kyphosis. The anatomic location of the cyst was evaluated preoperatively via 3D reconstruction of computed tomography images to identify a site where safe fenestrated resection could be performed. This was challenging because the surgical field was narrow due to the presence of severe kyphosis, and there was a risk of damage to surrounding organs during fenestrated resection. The cyst was filled with a greater omentum because the opening site was covered due to compression of the liver by the costal arch, and there was a risk of recurrence. Even when severe kyphosis makes fenestration of the cyst difficult, laparoscopic surgery may be a useful option given the appropriate preoperative preparation.