Double swing manoeuver to expose the right posterior segments during laparoscopic liver surgery

Abstract

The benefits of laparoscopic liver surgery have been well described. Laparoscopic liver resections are now performed widely, but is difficult to accomplish in some anatomical locations such as the posterosuperior segments. Resections including segment 7 and 8 require full mobilisation of the right liver lobe and ability to rotate to the left in an effort to bring the posterior segments in an anterior view. Tilting the operating table to the left to benefit from the gravity effect and the weight of the liver are important but most of the times not enough in laparoscopic surgery. In addition, the falciform is a very strong ligament that can be used to retract the liver. Falciform traction though for exposure of the right posterior segments has the disadvantage of being too far away from the posterosuperior liver and commonly the liver is not fully rotated though the falciform is fully retracted. The gallbladder fundus can be used to further retract/rotate the liver to the left side in order to accomplish the best exposure of the right posterior sector and lower down the segment 8. Following right lobe mobilisation, gallbladder swing can reach the left subdiaphragmatic area/ splenic hilum. In this presentation we show in detail the technique used in most of our resections of right posterior segments through illustration and short videos.