Skip to main content
Log in

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

  • 2018 EAES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  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):825–830

    Article  Google Scholar 

  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):619–629

    PubMed  Google Scholar 

  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–A9

    Article  Google Scholar 

  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):745–753

    Article  Google Scholar 

  5. Couinaud C (1992) The anatomy of the liver. Ann Ital Chir 63(6):693–697

    CAS  PubMed  Google Scholar 

  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):90–97

    Article  Google Scholar 

  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):720–725

    Article  Google Scholar 

  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):3881–3889

    Article  Google Scholar 

  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):205–213

    Article  Google Scholar 

  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):643–650

    Article  Google Scholar 

  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):619–624

    Article  CAS  Google Scholar 

  12. Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93(1):67–72

    Article  CAS  Google Scholar 

  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):387–397

    Article  Google Scholar 

  14. Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256(6):959–964

    Article  Google Scholar 

  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):1630–1637

    Article  Google Scholar 

  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):2135–2143

    Article  Google Scholar 

  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):e17–21

    Article  Google Scholar 

  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):10267–10274

    Article  Google Scholar 

  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):1266

    Article  Google Scholar 

  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):358–365

    Article  Google Scholar 

  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):e2014.00040

    Article  Google Scholar 

  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):946–950

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Sung Hoon Choi.

Ethics declarations


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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.W., Choi, S.H., Kim, S. et al. Laparoscopic liver resection for segment VII lesion using a combination of rubber band retraction method and flexible laparoscope. Surg Endosc 34, 954–960 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: