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.
Similar content being viewed by others
References
Inoue Y, Hayashi M, Tanaka R, Komeda K, Hirokawa F, Uchiyama K. Short-term results of laparoscopic versus open liver resection for liver metastasis from colorectal cancer: a comparative study. Am Surg 2013;79:495–501.
Nord HJ. Laparoscopy-a historical perspective: are gastroenterologists going to reclaim it? Gastrointest Endosc 2008;68:67–68.
Nord HJ. Biopsy diagnosis of cirrhosis: blind percutaneous versus guided direct vision techniques—a review. Gastrointest Endosc 1982;28:102–104.
Gagner M, Rheault M, Dubuc J. Laparoscopic partial hepatectomy for liver tumor (abstract). Surg Endosc 1992;6:99.
Buell JF, Cherqui D, Geller DA, O'Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D'Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS. World Consensus Conference on Laparoscopic Surgery. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 2009; 250:825–30.
Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 2015;261:619–29.
Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G. Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing. Ann Surg 2016;263:761–77.
Ishizawa T, Gumbs AA, Kokudo N, Gayet B. Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 2012;256:959–964.
Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G. A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci. 2014;21:745–53.
Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK. Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8. J Hepatobiliary Pancreat Sci 2014;21:E65–8.
Inoue Y, Hayashi M, Komeda K, Masubuchi S, Yamamoto M, Yamana H, Kayano H, Shimizu T, Asakuma M, Hirokawa F, Miyamoto Y, Takeshita A, Shibayama Y, Uchiyama K. Resection margin with anatomic or nonanatomic hepatectomy for liver metastasis from colorectal cancer. J Gastrointest Surg 2012;16:1171–80.
Inoue Y, Tanaka R, Komeda K, Hirokawa F, Hayashi M, Uchiyama K. Fluorescence detection of malignant liver tumors using 5-aminolevulinic acid-mediated photodynamic diagnosis: principles, technique, and clinical experience. World J Surg 2014;38:1786–1794.
International Union Against Cancer (UICC). Sobin LH, Gospodarowicz MK, Wittekind CH, editors. TNM classification of malignant tumours. 7th edition. Wiley-Blackwell, New York, 2009.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187–196.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.
Morise Z. Perspective of laparoscopic liver resection for hepatocellular carcinoma. World J Gastrointest Surg 2015;7:102–106.
Helm EJ, Rahman NM, Talakoub O, Fox DL, Gleeson FV. Course and variation of the intercostal artery by CT scan. Chest 2013;143:634–639.
Carney M, Ravin CE. Intercostal artery laceration during thoracocentesis: increased risk in elderly patients. Chest 1979;75:520–522.
Choi S, Trieu J, Ridley L. Radiological review of intercostal artery: anatomical considerations when performing procedures via intercostal space. J Med Imaging radiat Oncol 2010;54:302–306.
Author information
Authors and Affiliations
Contributions
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.
Corresponding author
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.
Electronic supplementary material
(MPG 240360 kb)
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-017-3516-9