Surgical Endoscopy

, Volume 34, Issue 2, pp 954–960 | Cite as

Laparoscopic liver resection for segment VII lesion using a combination of rubber band retraction method and flexible laparoscope

  • Jin Woo Lee
  • Sung Hoon ChoiEmail author
  • Seungki Kim
  • Sung Won Kwon
2018 EAES Oral



Laparoscopic liver resection (LLR) for tumors involving segment VII has been considered a contraindication. Herein, our proposed laparoscopic technique for segment VII lesions using a rubber band retraction method and flexible laparoscope is introduced.


A combination of elastic rubber band retraction method and flexible laparoscope was applied to access segment VII lesion. The perioperative outcomes and pathologic results were compared between patients with segment VII lesions (group 1) and patients with tumors in other segments (group 2) to evaluate feasibility and safety of the proposed laparoscopic approach for segment VII lesions.


Among 167 patients who underwent LLR from May 2014 to October 2017, the study population included 17 patients with tumors in segment VII (group 1) and 66 patients with tumors in other segments (group 2). The demographics of the two groups were comparable. One open conversion occurred in group 2 due to bleeding. The mean tumor size was 2.6 ± 1.0 and 2.5 ± 1.5 cm (p = 0.392) and surgical margin was 1.2 ± 0.7 and 1.3 ± 1.2 cm (p = 0.344) in group 1 and group 2, respectively. The mean operation time was 151 ± 63 and 131 ± 57 min (p = 0.596) and estimated mean blood loss was 294 ± 281 and 306 ± 405 mL (p = 0.610), in group 1 and group 2, respectively. The mean postoperative hospital stay was 6.1 ± 1.5 and 6.4 ± 2.7 days (p = 0.064) in group 1 and group 2. Two postoperative complications in both groups and no postoperative mortality occurred.


The combination technique of rubber band retraction and flexible laparoscopic camera allowed feasible and safe LLR for segment VII lesions that showed postoperative outcomes comparable to other segment lesions.


Hepatectomy Liver resection Laparoscopic Minimally invasive 


Compliance with ethical standards


Dr. Jin Woo Lee, Sung Hoon Choi, Seungki Kim, and Sung Won Kwon have no conflicts of interest or financial ties to disclose.


  1. 1.
    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 (2008) Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville statement. Ann Surg 250(5):825–830CrossRefGoogle Scholar
  2. 2.
    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, Schon 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 (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629PubMedGoogle Scholar
  3. 3.
    Cho JY, Han HS, Wakabayashi G, Soubrane O, Geller D, O’Rourke N, Buell J, Cherqui D (2018) Practical guidelines for performing laparoscopic liver resection based on the second international laparoscopic liver consensus conference. Surg Oncol 27(1):A5–A9CrossRefGoogle Scholar
  4. 4.
    Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21(10):745–753CrossRefGoogle Scholar
  5. 5.
    Couinaud C (1992) The anatomy of the liver. Ann Ital Chir 63(6):693–697PubMedGoogle Scholar
  6. 6.
    Gigot JF, Glineur D, Santiago Azagra J, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236(1):90–97CrossRefGoogle Scholar
  7. 7.
    Otsuka Y, Tsuchiya M, Maeda T, Katagiri T, Isii J, Tamura A, Yamazaki K, Kubota Y, Suzuki T, Suzuki T, Kagami S, Kaneko H (2009) Laparoscopic hepatectomy for liver tumors: proposals for standardization. J Hepatobiliary Pancreat Surg 16(6):720–725CrossRefGoogle Scholar
  8. 8.
    Kazaryan AM, Rosok BI, Marangos IP, Rosseland AR, Edwin B (2011) Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 25(12):3881–3889CrossRefGoogle Scholar
  9. 9.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  10. 10.
    Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63(3):643–650CrossRefGoogle Scholar
  11. 11.
    Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D (2007) Laparoscopic liver resection: results for 70 patients. Surg Endosc 21(4):619–624CrossRefGoogle Scholar
  12. 12.
    Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93(1):67–72CrossRefGoogle Scholar
  13. 13.
    Choi SH, Choi GH, Han DH, Choi JS (2015) Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases. Surg Endosc 29(2):387–397CrossRefGoogle Scholar
  14. 14.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256(6):959–964CrossRefGoogle Scholar
  15. 15.
    Yoon YS, Han HS, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24(7):1630–1637CrossRefGoogle Scholar
  16. 16.
    Inoue Y, Suzuki Y, Fujii K, Kawaguchi N, Ishii M, Masubuchi S, Yamamoto M, Hirokawa F, Hayashi M, Uchiyama K (2017) Laparoscopic liver resection using the lateral approach from intercostal ports in segments VI, VII, and VIII. J Gastrointest Surg 21(12):2135–2143CrossRefGoogle Scholar
  17. 17.
    Okuda Y, Honda G, Kurata M, Kobayashi S, Sakamoto K, Takahashi K (2015) A safe and valid procedure for pure laparoscopic partial hepatectomy of the most posterosuperior area: the top of segment 7. J Am Coll Surg 220(3):e17–21CrossRefGoogle Scholar
  18. 18.
    Morise Z (2016) Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: a new technical approach. World J Gastroenterol 22(47):10267–10274CrossRefGoogle Scholar
  19. 19.
    Herman P, Kruger JA, Perini MV, Coelho FF, Lupinacci RM (2013) Laparoscopic hepatic posterior sectionectomy: a hand-assisted approach. Ann Surg Oncol 20(4):1266CrossRefGoogle Scholar
  20. 20.
    Ogiso S, Conrad C, Araki K, Nomi T, Anil Z, Gayet B (2015) Laparoscopic transabdominal with transdiaphragmatic access improves resection of difficult posterosuperior liver lesions. Ann Surg 262(2):358–365CrossRefGoogle Scholar
  21. 21.
    Patriti A, Cipriani F, Ratti F, Bartoli A, Ceccarelli G, Casciola L, Aldrighetti L (2014) Robot-assisted versus open liver resection in the right posterior section. JSLS 18(3):e2014.00040CrossRefGoogle Scholar
  22. 22.
    Bin J, Binghai Z, Sanyuan H (2016) Liver exposure using sterile glove pouch during laparoscopic right liver surgery in hepatocellular carcinoma patients. World J Surg 40(4):946–950CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Hepatobiliary and Pancreas, Department of SurgeryCHA Bundang Medical Center, CHA UniversitySeongnam-SiKorea

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