title: Total abdominal approach for postero-superior segments (7, 8) in laparoscopic liver surgery: a multicentric experience.
abstract: Laparoscopic liver resections are frequently performed for peripheral lesions located in the antero-inferior segments. Resection of postero-superior segments is more demanding and dangerous than other segmentectomies, resulting in a longer operation time and increased blood loss. To reduce technical challenges, some authors advocated a modified surgical approach for these segments with the patient placed in the left lateral decubitus with the right arm suspended and suggested technical variations like the use of an additional intercostal trocar, the placement of one or two additional trans-thoracic trocars, a hand-assisted approach or a hybrid method with a median laparotomy. In the present series of 88 patients from four hepatobiliary centers with high volume of activity in Italy, a standard lithotomic position has been routinely used without the need for left lateral decubitus or semi-prone position and through abdominal wall without use of trans-thoracic trocars. This approach allows a more comfortable use of the Pringle maneuver that we used routinely in hepatic resection for PS segments; and, a very short time is needed for conversion, whenever it is required. In our series, laparoscopic resection of liver tumors located in the postero-superior segments of the liver with a total abdominal approach is technically feasible and safe with short-term results similar to other laparoscopic liver resections.
authors.affiliation: Unit of Hepatobiliary Surgery and Liver Transplant Center, Cardarelli Hospital, Naples, Italy, giuldoc@hotmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giuliani
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Ettorre
authors.forename: Paolo
authors.initials: P
authors.lastname: Bianco
authors.forename: Francesca
authors.initials: F
authors.lastname: Ratti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantino
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.forename: Emanuele
authors.initials: E
authors.lastname: Felli
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007558:Italy; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D056888:Patient Positioning; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome