Surgical Endoscopy

, Volume 28, Issue 1, pp 314–314 | Cite as

Thoracoscopic hepatectomy for malignant liver tumor

  • Masayasu Aikawa
  • Mitsuo Miyazawa
  • Kojun Okamoto
  • Yasuko Toshimitsu
  • Katsuya Okada
  • Yosuke Ueno
  • Shigeki Yamaguchi
  • Isamu Koyama
Video

Abstract

Background

Anatomical position of the liver poses a difficulty in approaching the lesions using a laparoscopic approach.

Methods

The patient was a 79-year-old man with a surgical history of laparoscopic sigmoidectomy for colon cancer and posterior segmentectomy of the liver for metastatic liver tumor. On admission, he presented with another liver tumor (diameter, 1.5 cm) in the dome of segment VIII. Because of the high possibility of severe adhesion around the liver and difficulty of approaching the lesion from the abdomen, we selected the transthoracic approach rather than the abdominal approach; the patient consented to this procedure.

The patient was placed in the left-lateral position under general anesthesia with single-lung ventilation. We placed three trocars into the right thoracic space. The intrathoracic space was observed using a flexible-tip rigid scope (Olympus, Tokyo, Japan). The tumor was detected by inserting a flexible laparoscopic ultrasound probe (Hitachi Aloka, Ltd., Tokyo, Japan) through the diaphragm; the diaphragm was dissected immediately above the tumor using a harmonic scalpel (Ethicon Endo-Surgery, Inc., Cornelia, GA). The liver surface was precoagulated using a low-voltage monopolar coagulator with a ball-shaped tip (Amco Inc., Tokyo, Japan) with the electrosurgical unit VIO300D (Erbe Elektromedizin, Tuebingen, Germany). The parenchyma was first sealed using BiClamp LAP forceps (Erbe Elektromedizin) and divided using the harmonic scalpel. The specimen was extracted using a retrieval bag. After complete hemostasis was achieved, the diaphragm was closed by continuous suturing.

Results

The operation lasted for 310 min and estimated blood loss was 10 mL. The patient was discharged on postoperative day 4.

Conclusions

Although the duration of TH was long because of the narrow thoracic cavity space, TH was performed without any problems. As a rule, we should select TH for lesions located in the dorsal segment VII/VIII, with severe adhesion around the liver.

Keywords

Thoracoscopic hepatectomy Transdiaphragmatic hepatectomy Partial hepatectomy Metastatic liver tumor 

Supplementary material

Supplementary material 1 (MPG 268296 kb)

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Masayasu Aikawa
    • 1
  • Mitsuo Miyazawa
    • 1
  • Kojun Okamoto
    • 1
  • Yasuko Toshimitsu
    • 1
  • Katsuya Okada
    • 1
  • Yosuke Ueno
    • 1
  • Shigeki Yamaguchi
    • 1
  • Isamu Koyama
    • 1
  1. 1.Gastrointestinal Center, Department of SurgerySaitama Medical University International Medical CenterHidakaJapan

Personalised recommendations