[Hepatectomy with an additional parasternal incision without thoracotomy]

A 74-year-old woman was diagnosed with hepatocellular carcinoma in S8 and underwent partial hepatectomy. A 5-cm right parasternal skin incision was added to the median incision, followed by division of the two costal cartilages, which resulted in excellent exposure of the subphrenic portion of the liver including the root of hepatic veins. The authors used this access technique in 7 patients over the past 12 months, and a satisfactory operative field was achieved in all cases. This simple technique without thoracotomy may be useful as an alternative access to the liver, especially when fine isolation around the root of the hepatic veins is required.