title: Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions.
abstract: BACKGROUND
  Dome liver lesions (those in segments VII or VIII) pose a challenge to standard laparoscopic resection. The use of additional intercostal and transthoracic trocars (ITTs) potentially facilitates resection over standard subcostal laparoscopic (SSL) techniques.
  
  
  METHODS
  A retrospective review of a prospectively collected liver resection database was performed, selecting all minor resections of segments VII and VIII using the ITT and SSL approaches. The techniques of intercostal transdiaphragmatic access are described and the surgical outcomes of the two groups compared.
  
  
  RESULTS
  A total of 19 patients were analysed. The ITT group included 8 patients and the SSL group included 11. The groups were comparable in median lesion size (20 mm in the ITT group and 26 mm in the SSL group). Blood loss, operative times, morbidity and conversion rates were similar. There was no lung injury or postoperative clinical pneumothorax in any patient undergoing transdiaphragmatic access. Median hospital stay was significantly shorter in the ITT group (2 days) than in the SSL group (6 days) (P = 0.032).
  
  
  CONCLUSIONS
  The ITT approach is safe, effective and complementary to standard laparoscopic techniques for the resection of small tumours in segments VII and VIII.
authors.affiliation: Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
authors.forename: Adrian K H
authors.initials: AK
authors.lastname: Chiow
authors.forename: Joel
authors.initials: J
authors.lastname: Lewin
authors.forename: Bavahuna
authors.initials: B
authors.lastname: Manoharan
authors.forename: David
authors.initials: D
authors.lastname: Cavallucci
authors.forename: Richard
authors.initials: R
authors.lastname: Bryant
authors.forename: Nicholas
authors.initials: N
authors.lastname: O'Rourke
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D004867:Equipment Design; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D013525:Surgical Instruments; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome