âCombined Laparoscopic and Trans-Thoracic Approachâ for Limited Liver Resections

摘要: Background: Since the very first report and through to last two decades, laparoscopy has demonstrated be an effective tool for liver surgery, especially limited resections. Despite increasing experience worldwide multitude of instruments energy based devices parenchymal transection, some locations remain difficult laparoscopic Posterior upper right segments (segments 7 8) are still tricky exposed properly while using a standard approach. We present new technique with Combined Laparoscopic Trans-Thoracic Approach (CLTTA) reach in enabling resections conserving advantages minimally invasive surgery. Methods: Three patients underwent resection CLTTA. The patient had metastasis colonic cancer, second inflammatory adenoma third nodule suspected HCC underlying cirrhosis. All lesions were located between 8. Results: procedures performed Four ports placed abdomen supplementary 5 mm pleural cavity. Parenchymal transection was done every case either harmonic scalpel (Ultracision, Ethicon Endosurgery, Cincinnati, OH) or vessel sealing device (Ligasure, Covidien-Valleylab, Boulder, CO) superficial centimetres then Ultrasonic Surgical Aspirator (Sonosurg, Olympus, Tokyo, Japan) deeper transection. Haemostasis achieved bipolar coagulator clips when necessary. Chest tube left place days after surgery. No transfused. conversion, morbidity mortality observed. Conclusions: our early this that seems feasible safe posterior liver. Further is needed order confirm these data.