title: Laparoscopic enucleation of liver tumors. Corkscrew technique revisited.
abstract: BACKGROUND
  Enucleation of small lesions located near the hepatic surface can be achieved with low morbidity and mortality. This article describes a simple laparoscopic technique for enucleation of liver tumors.
  
  
  METHODS
  After inspection and intraoperative ultrasonography, Glisson's capsule is marked with eletrocautery 2 cm away from the tumor margin. Ultrasonography is used to ascertain surgical margin right before liver transection. Hemihepatic ischemia is applied and marked area is anchored by stitches. The suture is held together by metallic clips and upward traction is performed, facilitating the transection of the parenchyma and correct identification of vascular and biliary structures.
  
  
  RESULTS
  This technique has been successfully employed in six consecutive patients. There were four men and two women, mean age 50.3 years. Four patients underwent liver resection for malignant disease and two for benign liver neoplasm. Pathologic surgical margins were free in all cases and mean hospital stay was 2 days. No postoperative mortality was observed.
  
  
  CONCLUSIONS
  This technique may facilitate laparoscopic nonanatomical liver resection and reduce risk of positive surgical margins. It is also useful in combination with anatomical laparoscopic liver resections such as right or left hemihepatectomies in patients with bilateral liver tumors as occurred in one of our patients.
authors.affiliation: Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
authors.forename: Fabio F
authors.initials: FF
authors.lastname: Makdissi
authors.forename: Rodrigo C T
authors.initials: RC
authors.lastname: Surjan
authors.forename: Marcel Autran C
authors.initials: MA
authors.lastname: Machado
mesh_terms: D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013536:Suture Techniques; D016896:Treatment Outcome