Video-Assisted Thoracoscopic Transdiaphragmatic Liver Resection For Malignant Tumors Located In The Posterosuperior Segments.

469 Background: Laparoscopic liver resection has recently become more common. However, it is difficult to resect laparoscopically the liver tumor located in the posterosuperior segments (IVa, VII and VIII), especillay for patients with liver cirrhosis. Compared to laparoscopy, gaining access to tumors in the dome of the liver may be more easily obtained via thoracoscopy.Therefore, we describe the technique and outcome of a video-assisted thoracoscopic transdiaphragmatic liver resection in patients with a malignant tumor of the liver. Methods: Five female patients underwent video-assisted thoracoscopic transdiaphragmatic partial hepatectomy. The tumors were located at segment VIII in 4 patients and segment VII in 1. Three patients were preoparatively diagnosed with hepatocellular carcinoma, and two were metastatic tumor of the colorectal cancer. Underlying cirrhosis was staged as Child-Pugh B in 2 cases and Child-Pugh A in 1. Thoracoscopic transdiaphragmatic partial hepatic resection was chosen due to the tumor’s location and impaired liver function. The patient was placed in an oblique position with her left side on the table. The ports were placed around the tumor at three levels, the ninth (3cm mini-thoracotomy), the seventh (two ports, 5mm and 12mm), and the fifth (12mm) intercostals spaces. Using thoracoscopic ultrasonography, the portion of the diaphragm located just above the tumor was cut and opened using electric cautery. The partial liver resection was performed using coagulating shears and electric cautery. Results: No conversion to laparotomy occurred. The median blood loss was 200 g (20-500g), and median operating time was 220 min (135-347 min). There were no perioperative deaths, and no patients underwent reoperation. Conclusions: Thoracoscopic hepatic resection can be safely performed in patients with subdiaphragmatic tumors, especially with cirrhosis or previous upper abdominal surgery.