title: Our technique of preceding diaphragm resection and partial mobilization of the hepatic right lobe using a vessel sealing device (LigaSure™) for huge hepatic tumors with diaphragm invasion.
abstract: We describe and assess our technique of preceding diaphragm resection and partial mobilization of the hepatic right lobe to treat a huge hepatic tumor with diaphragm invasion. The right hepatic artery and portal vein were divided at the hepatic hilum, and the mesenteries were then dissected with a vessel sealing device (LigaSure Impact™). The invaded diaphragm was dissected roundly using a vessel sealing device and the right lobe was partially mobilized. A soft catheter was then passed along the anterior aspect of the retrohepatic inferior vena cava and the liver parenchyma was dissected via a liver hanging maneuver. We performed eight hepatectomies using this technique. The median blood loss was 532.5 ml and the mean excised liver weight was 1859 g. Our results demonstrate the safety and efficiency of the preceding diaphragm resection and partial mobilization technique using a vessel sealing device for right hepatectomy to resect a very large tumor with diaphragm invasion.
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan. k-wakayama@med.hokudai.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakayama
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kakisaka
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Orimo
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Shimada
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuruga
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15-W7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003964:Diaphragm / Q000473:pathology* / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D065506:Vascular Closure Devices; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Diaphragm invasion; Liver tumor; Resection