Laparoscopic segment 8 liver resection

Abstract

Presenter: Chaya Shwaartz MD | University Health Network, Toronto General Hospital Background: Laparoscopic resection of segment 8 liver lesions is technically challenging due to the anatomical complexity of the liver as well as the location of segment 8 in the dome of the liver1. In fact, segment 8 resections are considered to be one of the most challenging laparoscopic liver resections2–4. Additionally, expertise in laparoscopic surgery is needed to safely expose and dissect the hepatic veins. We present a case of a laparoscopic segment 8 resection with transthoracic trocar use. Methods: Case presentation: This is a video presentation of a 66 year-old male with a history of locally advanced rectal adenocarcinoma for which he underwent neoadjuvant chemoradiation followed by a pelvic exenteration. He was then diagnosed with a single colorectal liver metastasis in segment 8 and was started on chemotherapy with a good response. Subsequently, the patient was taken to the operating room for a laparoscopic segment 8 liver resection preserving the right and middle hepatic veins. We used intraoperative ultrasound for accurate anatomical evaluation. For the parenchymal transection, a cavitron ultrasonic surgical aspirator (CUSA) was used as well as an energy device under intermittent pringle maneuver. A trans-thoracic trocar was also introduced for better exposure and to approach the most superior aspect of the lesion. Estimated blood loss was 200 cc. Results: Final pathology showed 3.2 cm adenocarcinoma with negative resection margins. The patient had an uneventful post-operative recovery with no evidence of recurrence. Conclusion: Conclusion: Laparoscopic segment 8 liver resection is feasible and safe when performed in tertiary liver surgery centers. Trans-thoracic approach allows access to the most posterior and superior segments of the liver.