title: Application of marionette technique for 3-port laparoscopic liver resection.
abstract: BACKGROUND
  Laparoscopic liver resection has become a feasible and safe procedure for liver tumor, but it requires experienced surgeons in the case of hepatobiliary and laparoscopic surgeries. More minimally invasive laparoscopic techniques of liver surgery are developed. We here report our experience of using a marionette technique for 3-port laparoscopic liver resection.
  
  
  METHODS
  Between June 2009 and December 2010, 7 patients underwent 3-port laparoscopic liver resection with the use of marionette technique. Five patients had hepatocellular carcinoma. Two patients with prior abdominal operations for colon cancer had colorectal liver metastasis. The procedure of marionette technique was performed as below: after insertion of the 3 trocars, a 2-0 nylon straight needle line was inserted through the abdominal wall, and using the needle holder, it was allowed to traverse the liver edge twice. Then, the straight needle line was forced out of the abdominal wall and clamped using mosquito for traction. Another straight needle line was similarly created at the opposite side of the liver edge.
  
  
  RESULTS
  None of the patients had to be converted to open surgery. The mean operative time was 96.7 ± 63.2 minutes (range, 45 to 195 min), and the mean volume of blood loss was 45.6 ± 27.9 mL (range, 30 to 100 mL). The mean pain score recorded on the visual analog scale was 2.7 ± 0.8. The mean hospital stay was 5.6 ± 1.7 days (range, 4 to 9 d). Currently, all the 7 patients are alive, and the tumors have not recurred (Supplementary Digital Content video 1 http://links.lww.com/SLE/A67).
  
  
  CONCLUSIONS
  Our experience demonstrated that the simple marionette technique procedure could help surgeons ease laparoscopic liver resection and achieve better postoperative results.
authors.affiliation: Department of Surgery, National Defense Medical Center, Division of General Surgery, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Kuo-Feng
authors.initials: KF
authors.lastname: Hsu
authors.forename: Tsang-Pai
authors.initials: TP
authors.lastname: Liu
authors.forename: Jyh-Cherng
authors.initials: JC
authors.lastname: Yu
authors.forename: Teng-Wei
authors.initials: TW
authors.lastname: Chen
authors.forename: Ming-Lang
authors.initials: ML
authors.lastname: Shih
authors.forename: Kuang-Ling
authors.initials: KL
authors.lastname: Ou
authors.forename: Cheng-Jueng
authors.initials: CJ
authors.lastname: Chen
authors.forename: De-Chuan
authors.initials: DC
authors.lastname: Chan
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D016896:Treatment Outcome