Video‐assisted Thoracoscopic Surgery: Hepatectomy for Liver Neoplasm

Abstract

Laparoscopic liver resection has recently gained wide acceptance for various liver tumors, thanks to advances in surgical techniques and devices. However, if the tumor is located in the subdiaphragmatic area of segments 7 and 8, resection is difficult. We demonstrate herein a novel technique for video-assisted thoracoscopic surgery hepatectomy (VATS-H) for liver tumors located in the subdiaphragmatic area. Five patients underwent VATS-H for a liver neoplasm. One port or two ports and two laparoscopic protectors were placed on the chest surrounding the tumor. Using intraoperative thoracoscopic ultrasonography (IOTU), the portion of the diaphragm located just above the tumor was cut and opened using laparoscopic coagulating shears. IOTU was performed on the liver surface, and the tumor margin was marked by electrocautery. For liver resection, microwave tissue coagulation or radiofrequency ablation was used for coagulation before liver transection and for coagulation of liver parenchyma during the transection. The mean operating time was 137min (range 95-185min), and the mean operative blood loss was 43g (range 0-200g). No postoperative complications were encountered. VATS-H appears useful for resecting liver tumors located in the subdiaphragmatic area.