Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors



The aim of this study was to demonstrate the detailed surgical techniques of laparoscopic hepatectomy using intercostal transthoracic trocars for subcapsular tumors located in segment VII or VIII.


Intercostal transthoracic trocars were used in patients undergoing laparoscopic hepatectomy for tumors located in segment VII or VIII. Following establishment of pneumoperitoneum and placement of abdominal trocars, balloon-tipped trocars were inserted into the abdominal cavity from the intercostal space and through the pleural space and diaphragm. Upon placement of the intercostal trocars, the lung edge was confirmed by ultrasonography and laparoscopic examination. Following minimal mobilization of the right liver, hemispherical wedge resection of segment VII or VIII was performed using the intercostal trocars as a camera port or for the forceps of the surgeon’s left hand. After the hepatectomy, the holes in the diaphragm were sutured closed.


Among the 79 patients who underwent laparoscopic hepatectomy, intercostal trocars were used in 14 patients for resection of tumors located in segment VII (4 nodules) or VIII (10 nodules). The median (range) operation time and amount of blood loss for hepatectomy were 225 (109–477) min and 60 (20–310) mL, respectively. No postoperative complications associated with hepatectomy or the use of intercostal trocars occurred.


Use of intercostal transthoracic trocars is safe and effective not only for complicated laparoscopic hepatectomy but also for hemispherical wedge resections of subcapsular hepatic tumors located in segment VII or VIII.

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This work was supported by Grants from the Mochida Memorial Foundation for Medical and Pharmaceutical Research (Ishizawa) and the Ministry of Health, Labour and Welfare of Japan (Ishizawa).

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Correspondence to Takeaki Ishizawa.

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Hirofumi Ichida, Takeaki Ishizawa, Masayuki Tanaka, Muga Terasawa, Genki Watanabe, Yoshinori Takeda, Ryota Matsuki, Masaru Matsumura, Taigo Hata, Yoshinori Mise, Yosuke Inoue, Yu Takahashi, and Akio Saiura have no conflicts of interest or financial ties to disclose.

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Ichida, H., Ishizawa, T., Tanaka, M. et al. Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors. Surg Endosc 31, 1280–1286 (2017) doi:10.1007/s00464-016-5107-3

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  • Laparoscopic hepatectomy
  • Intercostal trocar
  • Transthoracic trocar
  • Lateral approach
  • Fluorescence imaging