title: Additional right parasternal incision without thoracotomy provides alternative access for hepatic resection.
abstract: 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.
authors.affiliation: Department of Surgery, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, 543-8922, Tennoji-ku, Osaka, Japan. ttono@gin.or.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tono
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kanoh
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Nakano
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwazawa
authors.forename: Shigeo
authors.initials: S
authors.lastname: Matsui
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yano
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Kinuta
authors.forename: Jun
authors.initials: J
authors.lastname: Okamura
authors.forename: Takushi
authors.initials: T
authors.lastname: Monden
mesh_terms: 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