Use of Transthoracic Transdiaphragmatic Approach Assisted with Radiofrequency Ablation for Thoracoscopic Hepatectomy of Hepatic Tumor Located in Segment VIII

• Published in: Journal of gastrointestinal surgery 2019-08, Vol.23 (8), p.1547-1548
• Main Authors: Qin, Li, Fei, Liu, YongGang, Wei, Bo, Li
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - surgery; Catheter Ablation - methods; Diaphragm - surgery; Endoscopy; Gastroenterology; Hepatectomy; Hepatectomy - methods; Humans; Laparoscopy; Laparoscopy - methods; Liver cancer; Liver cirrhosis; Liver Neoplasms - diagnosis; Liver Neoplasms - surgery; Male; Margins of Excision; Medicine; Medicine & Public Health; Operative Time; Patients; Surgery; Systematic review; Tumors; Ultrasonic imaging; Ultrasonography
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04172-6

Background Resection of segment VIII remains challenging despite the widespread laparoscopic hepatectomies in past decades, 1 , 2 especially for patients with cirrhosis. In this case, we combined radiofrequency ablation (RFA) with transthoracic approach, which was a novel approach for laparoscopic-guided hepatectomy of segment VIII in a cirrhotic patient. Patient A 42-year-old male patient with a body mass index of 22.0 kg/m 2 suffered from HBV-related cirrhosis was admitted to our institution. The preoperative MRI showed a 1.3 cm liver mass located in segment VIII. The preoperative AFP is 192 ng/ml. The patient was considered to have hepatectomy using transthoracic transdiaphragmatic approach with the assist of RFA. Technique The patient was placed in a left lateral position with artificial pneumothorax in the right lung and left side ventilation. Three trocars were placed into the right thoracic space. Transdiaphragmatic intraoperative ultrasonography (IOUS) was performed to confirm the size and location of the lesion. In order to decrease the blood loss during parenchymal dissection and to reach tumor-free margins, the RFA was performed around the tumor before hepatectomy. After that the resection was carried out along the ablative margin. After the specimen was removed, the diaphragm was sutured and a closed thoracic drainage tube was placed. The operative time was 210 min with an estimated blood loss of 50 mL. The postoperative course was uneventful. Antibiotics was used in the first 24 h post-operation to prevent thoracic infection. Drainage tube was pulled out on the fourth day post-operation when we observed the daily fluid volume was less than 100 ml for 2 days and X-ray showed no gases and effusion in chest cavity. The pathology confirmed the diagnosis of hepatocellular carcinoma and the surgical margin was negative. The patient was discharged on the 8th day after surgery. Discussion Lesions in the postero-superior segments still be challenging as we know. 3 Previous studies showed that the procedure’s results, such as the blood loss and operative time, were similar between thoracoscopic hepatectomy and laparoscopic hepatectomy, even the former was better. 2 , 4 Thus, for the superficial lesions in the postero-superior segments, and not more than 3 cm in diameter, thoracoscopic hepatectomy is recommended. Furthermore, a patient with a hostile abdomen who has a lesion in S7 or S8, transthoracic approach may be particularly helpful. However, functi