Laparoscopic segment 8 liver resection

Presenter: Chaya Shwaartz MD | University Health Network, Toronto General Hospital Background: Laparoscopic resection of segment 8 liver lesions is technically challenging due to the anatomical complexity as well location in dome liver1. In fact, resections are considered be one most laparoscopic resections2–4. Additionally, expertise surgery needed safely expose and dissect hepatic veins. We present a case with transthoracic trocar use. Methods: Case presentation: This video presentation 66 year-old male history locally advanced rectal adenocarcinoma for which he underwent neoadjuvant chemoradiation followed by pelvic exenteration. He was then diagnosed single colorectal metastasis started on chemotherapy good response. Subsequently, patient taken operating room preserving right middle used intraoperative ultrasound accurate evaluation. For parenchymal transection, cavitron ultrasonic surgical aspirator (CUSA) an energy device under intermittent pringle maneuver. A trans-thoracic also introduced better exposure approach superior aspect lesion. Estimated blood loss 200 cc. Results: Final pathology showed 3.2 cm negative margins. The had uneventful post-operative recovery no evidence recurrence. Conclusion: feasible safe when performed tertiary centers. Trans-thoracic allows access posterior segments liver. References:1.Krüger JAP, Coelho FF, Perini MV, Herman P. resection. Arq Bras Cir Dig ABCD = Brazilian Arch Surg. 2014;27(4):288-290. doi:10.1590/S0102-672020140004000142.Ome Y, Honda G, Doi M, Muto J, Seyama Y. Anatomic Liver Resection Segment Using Intrahepatic Glissonean Approach. J Am Coll 2020;230(3):e13-e20. doi:10.1016/j.jamcollsurg.2019.11.0083.Jang JY, Han H-S, Yoon YS, et al. Three-Dimensional Anatomical Glissonian Ann Surg Oncol. 2017;24(6):1606-1609. doi:10.1245/s10434-017-5778-6 4. Kim JH, H. Pure Ventral Area Transfissural 2019;26(13):4608-4609. doi:10.1245/s10434-019-07852-4