Laparoscopic Transabdominal With Transdiaphragmatic Access Improves Resection of Difficult Posterosuperior Liver Lesions. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Ogiso, Satoshi; Conrad, Claudius; Araki, Kenichiro; Nomi, Takeo; Anil, Zeynal; Gayet, Brice
• Is Part Of: Annals of surgery. Volume 262:Issue 2(2015:Aug.)
• Publication Date: 2015-08
• Subjects: colorectal metastasis -- laparoscopic liver resection -- posterosuperior segment -- transdiaphragmatic -- transthoracic; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001015
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: We describe the technical details and evaluate the safety, feasibility, and usefulness of a combined lateral and abdominal (CLA) approach for laparoscopic resection of liver segments 7 and 8. Background: Laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8 is technically challenging, and currently there is no standardized laparoscopic approach. Methods: Through review of a prospectively maintained database, we identified 44 patients who underwent laparoscopic resection of lesions in segment 7 or 8. Twenty-five patients required the CLA approach because their lesions were more posterosuperior and intraparenchymal; 19 patients underwent resection with a regular abdominal-only approach of more accessible anteroinferior lesions. We reviewed operative details and video footage of these operations and compared the outcomes of the 2 groups. Results: In the group treated with the CLA approach, deep location was more frequent (88% vs 42%; P = 0.035), median tumor diameter was larger (24.5 mm vs 15 mm; P = 0.114), and the median weight of the excised parenchyma was greater (56.5 g vs 23 g; P = 0.093). Median operative time was longer in the CLA approach group (217.5 minutes vs 165 minutes; P = 0.046), but blood loss, rate of conversion to open surgery, surgical margin status, morbidity, and mortality were similar between the 2 groups. Conclusions: The CLA approach permits safe laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8, allowing surgeons to overcome the difficulties of limited visualization and access to the target lesions. Abstract : Supplemental Digital Content is Available in the Text.This study demonstrates a new combined transdiaphragmatic (lateral) and abdominal approach for difficult-to-access posterosuperior liver lesions. Twenty-five patients undergoing resection of lesions deep within segments 7 and 8 via this new approach had noninferior outcomes compared with 19 patients undergoing an abdominal-only approach for anteroinferior and superficial lesions in segments 7 and 8.