Transdiaphragmatic approach facilitates resection of large (>12 cm) liver tumors

Abstract

Large liver tumors (>12 cm) in the upper part of the liver may be approached through a standard bilateral subcostal incision, combined with splitting of the hemidiaphragm, without the need for any kind of thoracic incision.

Adaptation of hepatectomy for huge hepatocellular carcinoma

“…It is sometimes difficult to obtain an adequate operative field for the upper part of the liver, especially with large tumors, using the conventional transabdominal approach . The transdiaphragmatic approach has been reported to facilitate the resection of large tumors in the upper part of the liver . The liberal use of thoracic extension and selective use of the anterior approach have been advocated to assist in the resection of large right‐lobe tumors ,.…”

“…15 The transdiaphragmatic approach has been reported to facilitate the resection of large tumors in the upper part of the liver. 23 The liberal use of thoracic extension and selective use of the anterior approach have been advocated to assist in the resection of large right-lobe tumors. 24,25 Median sternotomy with an anterior approach was also employed to open to the rib cage and shift the right lobe to the right side and up.…”

Should Diaphragmatic Involvement Preclude Resection of Large Hepatic Tumors?

“…All biliary and vascular branches encountered in the transection plane were suture ligated with Prolene suture. Outflow was restored first, allowing for control of backflow bleeding branches, and then inflow was released, as we have previously described [6, 7]. The diaphragmatic defect was afterwards primarily repaired in 28 patients by a continuous non‐absorbable suture (Nylon loop, size 0) in two rows.…”

Transthoracic approach for liver tumors

“…Extending an abdominal incision (subcostal, median or J-shaped incision) into the thorax is usually planned preoperatively in anticipation of difficulties in exposure or for vascular control [11].…”