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

Table 1 Approaches to laparoscopic liver resection for tumors located in the posterosuperior lesion

(A) Options for handling the right liver and acquiring a stable surgical field

Hand-assisted laparoscopic surgery

Hand usage and hand-port positioning without causing disturbance of the operative view and allowing for manipulation in the small subphrenic cage should be further discussed

Robotic liver resection

Intercostally-inserted powerful robotic arms and ports may cause damage to the chest wall and pleura and may be responsible for the reported higher incidence of pulmonary complications

Specific spacers (i.e., sterile glove pouch)

Spacer usage without causing disturbance of the operative view and allowing for manipulation in the small subphrenic cage should be established

Postural change (semi-left lateral - left lateral - semi-prone)1

Laparoscopic surgery facilitates the use of postural changes

(B) Options for access to posterosuperior lesions in the rib cage (Figure 1)

Lateral approach (using intercostal ports)

Caudal approach (using laparoscopic-specific caudal view)1

Thoracoscopic liver resection (for segment 8, but not segment 7)

¹Used in our approach.