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Laparoscopic Liver Resection Using the Lateral Approach from Intercostal Ports in Segments VI, VII, and VIII

Abstract

Background

Laparoscopic liver resection (LLR) has been developed as a minimally invasive surgery. However, challenges such as difficulty securing visibility and limited control of forceps make it difficult to complete LLR in hepatic segments VI, VII, and VIII. To overcome these challenges, we devised a surgical technique using intercostal ports. We termed this approach the lateral approach. This work describes our experience performing LLR using this approach and discusses the safety and effectiveness of this approach.

Methods

Between April 2011 and December 2016, data from 91 patients who underwent LLR with or without the intercostal port at a single institution were retrospectively analyzed regarding surgical outcomes, safety, and utility.

Results

LLR was performed for 32 patients with the intercostal port and for 59 patients without the intercostal port. The conversion rates to open surgery with and without intercostal ports were 3.1 and 25.4% (P = 0.008). In hepatic segments VII and VIII, the rates of conversion to open surgery were significantly lower for cases involving intercostal ports (6.7 vs. 42.9 and 0 vs. 38.9%; P = 0.035 and 0026, respectively); however, there were no differences in hepatic segment VI (0 vs. 7.4%; P = 0.563). There were no differences in operative time, blood loss volume, surgical margin, curative resection rate, or postoperative complication rate for LLR in all segments (VI, VII, and VIII). No adverse events due to placement of the intercostal port were observed in this set of patients.

Conclusion

LLR using the lateral approach and intercostal ports for hepatic segments VII and VIII resulted in a significant decrease in conversion rates to open surgery.

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Author information

YI conceived the study concept and design, was involved with patient care, and drafted the manuscript. YS, KF, NK, MI, SM, MY, FH, MH, and KU were involved with formation of the study concept and design, patient care, and drafting of the manuscript. All authors have read and approved the final version of the manuscript.

Correspondence to Yoshihiro Inoue.

Ethics declarations

All patients were fully informed of the study design according to the Ethics Committee on Clinical Investigation of Osaka Medical College Hospital (nos. 1828 and 1997) and provided written informed consent.

Funding Information

This work was supported by the Mitsui Life Social Welfare Foundation.

Conflict of Interest

The authors declare no conflict of interest.

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Inoue, Y., Suzuki, Y., Fujii, K. et al. Laparoscopic Liver Resection Using the Lateral Approach from Intercostal Ports in Segments VI, VII, and VIII. J Gastrointest Surg 21, 2135–2143 (2017). https://doi.org/10.1007/s11605-017-3516-9

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Keywords

  • Intercostal port
  • Lateral approach
  • Laparoscopic liver resection
  • Co-axial position
  • Triangular formation