title: Thoracoscopic hepatectomy for malignant liver tumor.
abstract: BACKGROUND
  Anatomical position of the liver poses a difficulty in approaching the lesions using a laparoscopic approach.
  
  
  METHODS
  The patient was a 79-year-old man with a surgical history of laparoscopic sigmoidectomy for colon cancer and posterior segmentectomy of the liver for metastatic liver tumor. On admission, he presented with another liver tumor (diameter, 1.5 cm) in the dome of segment VIII. Because of the high possibility of severe adhesion around the liver and difficulty of approaching the lesion from the abdomen, we selected the transthoracic approach rather than the abdominal approach; the patient consented to this procedure. The patient was placed in the left-lateral position under general anesthesia with single-lung ventilation. We placed three trocars into the right thoracic space. The intrathoracic space was observed using a flexible-tip rigid scope (Olympus, Tokyo, Japan). The tumor was detected by inserting a flexible laparoscopic ultrasound probe (Hitachi Aloka, Ltd., Tokyo, Japan) through the diaphragm; the diaphragm was dissected immediately above the tumor using a harmonic scalpel (Ethicon Endo-Surgery, Inc., Cornelia, GA). The liver surface was precoagulated using a low-voltage monopolar coagulator with a ball-shaped tip (Amco Inc., Tokyo, Japan) with the electrosurgical unit VIO300D (Erbe Elektromedizin, Tuebingen, Germany). The parenchyma was first sealed using BiClamp LAP forceps (Erbe Elektromedizin) and divided using the harmonic scalpel. The specimen was extracted using a retrieval bag. After complete hemostasis was achieved, the diaphragm was closed by continuous suturing.
  
  
  RESULTS
  The operation lasted for 310 min and estimated blood loss was 10 mL. The patient was discharged on postoperative day 4.
  
  
  CONCLUSIONS
  Although the duration of TH was long because of the narrow thoracic cavity space, TH was performed without any problems. As a rule, we should select TH for lesions located in the dorsal segment VII/VIII, with severe adhesion around the liver.
authors: Gastrointestinal Center, Department of Surgery, Saitama Medical University International Medical Center, Saitama, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan, aikawama@ybb.ne.jp.
authors: Masayasu
authors: M
authors: Aikawa
authors: Mitsuo
authors: M
authors: Miyazawa
authors: Kojun
authors: K
authors: Okamoto
authors: Yasuko
authors: Y
authors: Toshimitsu
authors: Katsuya
authors: K
authors: Okada
authors: Yosuke
authors: Y
authors: Ueno
authors: Shigeki
authors: S
authors: Yamaguchi
authors: Isamu
authors: I
authors: Koyama
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D003520:Cyclophosphamide; D004317:Doxorubicin; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008727:Methotrexate; D061646:Operative Time; D013906:Thoracoscopy / Q000379:methods*; D014750:Vincristine
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D008727:Methotrexate