title: Intercostal Trocars Enable Easier Laparoscopic Resection of Liver Tumors in Segments 7 and 8.
abstract: Laparoscopic resection of posterosuperior (PS) tumors of the liver is more difficult than that of anterolateral (AL) tumors, owing to the narrow surgical field in the PS location. In this retrospective cohort study, our aim was to determine if port insertion through the intercostal space would lead to improved outcomes for laparoscopic resection of tumors in PS liver segments 7 and 8.
  
  
  
  Between January 2006 and December 2015, 153 patients underwent laparoscopic resection of solitary liver tumors at Osaka Medical College Hospital. Of these, 107 patients had AL lesions, and 46 had PS lesions. Of the 46 patients with a PS lesion, 23 underwent an abdominal-only approach, and 23 underwent the intercostal trocar approach. Multivariate analyses were performed to investigate outcomes.
  
  
  
  Conventional abdominal-only laparoscopic resection of PS liver tumors resulted in prolonged surgical time (P = 0.031), increased bleeding (P = 0.012), and a higher open conversion rate (P = 0.022) compared with AL tumors. Among patients with PS tumors, the open conversion rate was significantly higher for those treated with the abdominal-only approach than with the intercostal trocar approach (P = 0.047). Appropriate surgical margins were obtained equally using the intercostal trocar approach (P = 0.648). There was no significant difference in occurrence of complications between the abdominal-only group and the intercostal trocar group.
  
  
  
  Using the intercostal trocar approach for PS liver lesions is a safe and effective method, which significantly reduced the open conversion rate compared with the conventional abdominal-only approach.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. sur122@osaka-med.ac.jp.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asakuma
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: Tetsunosuke
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D055815:Young Adult