Laparoscopic hepatectomy for dorsal region of the right lobe with a transthoracic port

Masayasu Aikawa, MD, PhD, Mitsuo Miyazawa, Katsuya Okada, Yukihiro Watanabe, Shigeki Yamaguchi, Shinichi Sakuramoto, Isamu Koyama. Gastrointestinal Center,Saitama Medical University, International Medical Center.

Introduction At present, laparoscopic hepatectomy is being commonly used for tumor resection, but the resection of tumors from dorsal region of the right lobe is difficult because of insufficient operative view. We attempted to reach liver tumors in dorsal region via the conventional laparoscopic approach with the addition of a transthoracic approach using a transthoracic port (TTP). In this report, we describe this modified procedure and evaluate its usefulness.

Materials and Methods . The present study included 10 patients: 4 with hepatocellular carcinoma, 4 with metastatic liver cancer, 1 with an intrahepatic bile duct tumor, and 1 with an intrahepatic cholangiocellular carcinoma. As the tumors were located in the head side of the liver at S7/8, and resection was believed to be the difficult by only laparoscopic approach, an adaptation of the method using a TTP was considered. The operations were performed with the patient placed in the left lateral decubitus position with separation lung ventilation. The first port for the camera was inserted in the umbilical region or left side of the umbilical region, and 3–4 additional ports were added in the abdominal cavity. After the collapse of the right lung, the chest was opened at the ninth or tenth intercostals at the axillary line and a 12-mm balloon trocar (blunt tip trocar, Auto Suture) was inserted into the abdominal cavity through the diaphragm. The balloon port can prevent pneumothorax from occurring due to pneumoperitoneum.

Results The operation time was 308(153–477) minutes, and blood loss was 164(0–500) mL. There were no postoperative complications, including respiratory problems. The patients were discharged from the hospital approximately 9 days after the operation.

Conclusions By using a TTP, we identified the margins of the tumors, which are not easily detected via a laparoscopic approach, and safely performed the operation. Thus, the TTP is useful for the resection of a tumor located in S7 or S8 of the liver.

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