Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8

Abstract

Performing laparoscopic liver resection for lesions located in segment 7 and 8 is technically difficult, as the operative field is far from the conventional trocar site, and the liver impedes free motion of the laparoscopic instrument. Inserting the port through the intercostal space (ICS) may facilitate liver resection for these lesions. From January 2012 to July 2013, five patients (four men and one woman) underwent laparoscopic S7 or 8 segmentectomy for liver metastasis and hepatocellular carcinoma (HCC). Ports were inserted at the 7th and 9th ICS, respectively, in addition to conventional abdominal ports. The mean age was 58 ± 10 (45-74) years; operation time, 197 ± 68 (110-300) minutes; blood loss, 161 ± 138 (40-320) ml; and length of hospital stay, 7 ± 3 (4-12) days. Pathologic findings revealed three, one, and one case(s) of colon cancer metastasis, breast cancer metastasis, and HCC, respectively. The mean tumor size and tumor-free margin were 2.2 ± 1.1 cm and 5.8 ± 1.9 mm, respectively. There were no postoperative complications. Laparoscopic liver resection using intercostal trocars could be a useful method for tumors located in segments 7 and 8 of the liver in selected patients.

A novel difficulty scoring system for laparoscopic liver resection

“…In "The Louisville Statement, 2008", resection of the posterosuperior segment was regarded as a major hepatectomy because of its technical difficulty, although a major hepatectomy in the open method conventionally refers to hemihepatectomies and trisectionectomies. It was also reported that resection at the right posterosuperior part of the liver may require the most advanced laparoscopic technique [13][14][15]. Such variations in difficulty according to the procedure of liver resection were mainly reflected in the weighted scores for "extent of liver resection" and "tumor location" in our difficulty scoring system (Fig.…”

Useful maneuvers for precise laparoscopic liver resection

“…Additionally, the location of the ports varies depending on the surgeon's preferences, patient position, tumor location, and the type of resection . An intercostal or transthoracic port can be used for surgical instruments in some unfavorable regions, such as the posterosuperior segments .…”

Current Status of Laparoscopic Liver Resection: Experiences from Tertiary Center

“…27,28 In the setting of lesions in segment 7 or 8, we inserted intercostal ports at 7 th or 9 th ICS respectively. 29 If there is large cavities at the end of procedure, if possible we fill it with omentum in order to prevent the fluid collection and bowel adhesion there. 30 …”