Additional right parasternal incision without thoracotomy provides alternative access for hepatic resection.
BACKGROUND
Although hepatic resections are performed with various access approaches according to the location of the tumor, the extent of resection and patient's physical constitution, the exposure of the root of the hepatic veins is not optimal in some patients by any conventional incision.


METHODS
An additional 5 cm of right parasternal skin incision followed by division of two costal cartilages was performed in 8 patients, which demonstrated poor exposure of the upper part of the liver by abdominal incision.


RESULTS
In all cases, satisfactory exposure of the operative area was obtained without thoracotomy, and hepatic resection procedure was carried out without significant events.


CONCLUSIONS
This simple technique without necessitating rotation of the operating table may be useful as an alternative method of access to the liver especially when fine isolation around the root of the hepatic veins is required.
Tono
Takeshi
T
Department of Surgery, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, 543-8922, Tennoji-ku, Osaka, Japan. ttono@gin.or.jp
Kanoh
Toshiyuki
T
Nakano
Yoshiaki
Y
Iwazawa
Takashi
T
Matsui
Shigeo
S
Yano
Hiroshi
H
Kinuta
Masakatsu
M
Okamura
Jun
J
Monden
Takushi
T
D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D013249:Sternum; D013908:Thoracotomy