Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10267-10274
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10267
Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach
Zenichi Morise
Zenichi Morise, Department of Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
Author contributions: Morise Z performed the study and wrote the article.
Conflict-of-interest statement: The author declares no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zenichi Morise, MD, PhD, FACS, AGAF, Department of Surgery, Fujita Health University School of Medicine, 1-98 Kutsukakecho, Toyoake 470-1192, Japan. zmorise@fujita-hu.ac.jp
Telephone: +81-562-939246 Fax: +81-562-935125
Received: August 11, 2016
Peer-review started: August 12, 2016
First decision: September 12, 2016
Revised: September 27, 2016
Accepted: October 31, 2016
Article in press: October 31, 2016
Published online: December 21, 2016
Core Tip

Core tip: Laparoscopic liver resection for posterosuperior tumors is technically challenging because this area is located in the bottom of the small subphrenic cage, overlaid by the right liver. Thus, obtaining a fine surgical view is difficult and manipulation of the right liver is required to ensure hemostasis and obtainment of an appropriate surgical margin. The right liver may be handled by the hand-assisted approach, robotic liver resection, or a spacer-based approach. Intercostal ports can facilitate a direct lateral approach into the cage and postural changes may help. We successfully apply semi-prone positioning in the caudal approach without intercostal ports.