Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach

Figure 1 Liver resection (A), laparoscopic liver resection (regular caudal approach, B) and laparoscopic liver resection (lateral approach, C). Red arrows indicate the directions of the view and manipulation in each approach. A: In the open approach, the subcostal cage containing the liver is opened with a large subcostal incision, and instruments are used to lift the costal arch. The liver is dissected and mobilized (lifted) from the retroperitoneum; B: In the regular laparoscopic caudal approach, the laparoscope and forceps are placed into the subcostal cage from caudal direction, and surgery is performed with minimal alteration and destruction of the associated structures; C: In the laparoscopic lateral approach, the intercostal (transdiaphragmatic) ports combined with total mobilization of the liver from the retroperitoneumcan allow the direct lateral approach into the cage and to the posterosuperior tumors.