Lateral hand-assistance port for Laparoscopic posterior sectionectomy

Abstract

Background: The laparoscopic approach for lesion in posterosuperior location of liver is still challenging due to difficulty in traction and deep parenchymal dissection. Here we present a Case of 66-year-old female presented with abdominal pain and weight loss. CT Scan revealed a 4.4-cm lobulated cyst in liver segment6/7. Laparoscopic posterior sectionectomy with hand-assistance port at right lateral side was done. Methods: Trocars were placed. Pneumoperitoneum was made. The right hemiliver was fully mobilized. Intrahepatic posterior pedicle was controlled with the temporary inflow control of the glissonian pedicle (TICGL) technique.(1) Parenchymal dissection was proceed with ultrasonic dissector, CUSA and bipolar dissector. The hand-assistance port was made laterally. Surgeon’s left hand assisted in traction of the liver and in exposing the deeper parenchyma. The posterior pedicle was stapled. The right hepatic vein was resected. Specimen was put into a plastic bag. A Fortune drain was placed in subhepatic space and through the left lateral port. Results: The operative time was 8 hours 30 minutes. The estimated blood loss was 500 mL. No immediate postoperative complication. The drain was removed at postoperative day 5. The patient was discharged at postoperative day7. Histopathological report was lymphangioma with focal reactive change and calcification. Conclusion: Hand-assistance port can effectively assist in laparoscopic approach of posterosuperior location of liver, reducing operative time, less learning curve, while is still maintaining the benefit of laparoscopic surgery. Reference: Lee N, Cho CW, Kim JM, Choi GS, Kwon CHD, Joh JW. Application of temporary inflow control of the Glissonean pedicle method provides a safe and easy technique for totally laparoscopic hemihepatectomy by Glissonean approach. Ann Surg Treat Res. 2017;92(5):383-6.