Fully laparoscopic resection of segment VII: tips and tricks

Abstract

Background: Minimally invasive surgery can be challenging for hepatic lesions located in posterior-superior segments of the liver. Methods: We present a fully laparoscopic partial resection of segment VII for single metachronous metastasis of left colon adenocarcinoma. Results: A 57 years old man was diagnosed in 2014 with left colon adenocarcinoma treated by laparoscopic resection (pTNM:T3N0) MRI and PET CT performed in August 2016 showed a single 30 mm hepatic lesion in the segment VII consistent with metachronous metastasis. MDT decision was short course chemotherapy (4 cycles of FOLFOX) prior to surgery. In order to reassess the hepatic lesion, a new MRI scan was performed showing lesion stability and the patient underwent to a fully laparoscopic segment 7 resection. The patient was placed in a left lateral position. In total, we used 4 trocars (one 5 mm trocar and three 10 mm trocars). Intraoperative ultrasonography did not disclose additional lesions and the rest of abdominal exploration was normal. Partial resection of segment 7 was performed with CUSA, bipolar forceps and clips under intermittent Pringle maneuver (15 min with 5 min of release). An abdominal drain was left in place behind the right lobe of the liver. The patient was discharged at day 7 with an uneventful post-operative course. Pathology confirmed colorectal metastasis with 1.3cm margin. Four weeks after surgery, the chemotherapy was resumed. Conclusion: Safe laparoscopic liver resection in difficult segments requires specific patient position and port placement.