TY - JOUR
T1 - Total abdominal approach for postero-superior segments (7, 8) in laparoscopic liver surgery
T2 - a multicentric experience
AU - Giuliani, Antonio
AU - Aldrighetti, Luca
AU - Di Benedetto, Fabrizio
AU - Ettorre, Giuseppe Maria
AU - Bianco, Paolo
AU - Ratti, Francesca
AU - Tarantino, Giuseppe
AU - Santoro, Roberto
AU - Felli, Emanuele
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Laparoscopic liver resections are frequently performed for peripheral lesions located in the antero-inferior segments. Resection of postero-superior segments is more demanding and dangerous than other segmentectomies, resulting in a longer operation time and increased blood loss. To reduce technical challenges, some authors advocated a modified surgical approach for these segments with the patient placed in the left lateral decubitus with the right arm suspended and suggested technical variations like the use of an additional intercostal trocar, the placement of one or two additional trans-thoracic trocars, a hand-assisted approach or a hybrid method with a median laparotomy. In the present series of 88 patients from four hepatobiliary centers with high volume of activity in Italy, a standard lithotomic position has been routinely used without the need for left lateral decubitus or semi-prone position and through abdominal wall without use of trans-thoracic trocars. This approach allows a more comfortable use of the Pringle maneuver that we used routinely in hepatic resection for PS segments; and, a very short time is needed for conversion, whenever it is required. In our series, laparoscopic resection of liver tumors located in the postero-superior segments of the liver with a total abdominal approach is technically feasible and safe with short-term results similar to other laparoscopic liver resections.
AB - Laparoscopic liver resections are frequently performed for peripheral lesions located in the antero-inferior segments. Resection of postero-superior segments is more demanding and dangerous than other segmentectomies, resulting in a longer operation time and increased blood loss. To reduce technical challenges, some authors advocated a modified surgical approach for these segments with the patient placed in the left lateral decubitus with the right arm suspended and suggested technical variations like the use of an additional intercostal trocar, the placement of one or two additional trans-thoracic trocars, a hand-assisted approach or a hybrid method with a median laparotomy. In the present series of 88 patients from four hepatobiliary centers with high volume of activity in Italy, a standard lithotomic position has been routinely used without the need for left lateral decubitus or semi-prone position and through abdominal wall without use of trans-thoracic trocars. This approach allows a more comfortable use of the Pringle maneuver that we used routinely in hepatic resection for PS segments; and, a very short time is needed for conversion, whenever it is required. In our series, laparoscopic resection of liver tumors located in the postero-superior segments of the liver with a total abdominal approach is technically feasible and safe with short-term results similar to other laparoscopic liver resections.
KW - Hepatocellular carcinoma
KW - Laparoscopic liver resection
KW - Laparoscopic surgery
KW - Liver colorectal metastasis
KW - Segmentectomy
UR - http://www.scopus.com/inward/record.url?scp=84938360178&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84938360178&partnerID=8YFLogxK
U2 - 10.1007/s13304-015-0305-4
DO - 10.1007/s13304-015-0305-4
M3 - Article
C2 - 26076916
AN - SCOPUS:84938360178
VL - 67
SP - 169
EP - 175
JO - Updates in Surgery
JF - Updates in Surgery
SN - 2038-131X
IS - 2
ER -