Application of intercostal transthoracic trocars to laparoscopic hepatectomy

Takeaki Ishizawa, Hirofumi Ichida, Akio Saiura


Background: Since Couinaud’s hepatic segment VII and VIII are located at the cranial ends of the liver just beneath the diaphragm, resection of hepatic tumors in these regions is technically difficult even by open surgery. Recently, intercostal transthoracic trocars (ITT) have become widely used in laparoscopic hepatectomy for the tumors located in segment VII and/or VIII.
Methods: ITT have been used for laparoscopic hepatectomy, as described below: following pneumoperitoneum and placement of abdominal trocars, one or two balloon-tipped trocars are inserted into the abdominal cavity from intercostal space, through pleural space and the diaphragm. At this moment, lower edge of the right lung should be confirmed by ultrasonography and laparoscopic examination. Following minimal mobilization of the right liver, hepatic parenchyma is transected by using the intercostal trocars as a camera port or for the forceps of surgeon’s left hand. Incisions on the diaphragm are suture closed prior to closure of the abdominal wounds.
Results: Among the 121 patients who underwent laparoscopic hepatectomies, ITT was used in 17 patients (14%) for resection of tumors located in segment VII (n=6) or VIII (n=11). Median (range) operation time and amount of blood loss for hepatectomy were 226 [109–565] minutes and 70 [3–680] mL, respectively. No postoperative complications associated with the use of ITT occurred.
Conclusions: ITT can be used easily and safely, facilitating laparoscopic hepatectomy for the tumors located in segment VII and/or VIII.