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Additional right parasternal incision without thoracotomy provides alternative access for hepatic resection
Takeshi Tono1, Toshiyuki Kanoh, Yoshiaki Nakano
1Department of Surgery, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, 543-8922, Tennoji-ku, Osaka, Japan. ttono@gin.or.jp
American Journal of Surgery
|February 1, 2003
Summary
A novel surgical approach using a right parasternal incision improves liver access for hepatic resections, particularly for isolating hepatic veins. This technique offers a safe alternative without requiring thoracotomy.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Surgical anatomy
Background:
- Conventional surgical incisions for hepatic resections may not provide optimal exposure of the hepatic vein roots.
- Tumor location, resection extent, and patient constitution influence the choice of surgical approach.
Purpose of the Study:
- To evaluate a modified surgical approach for improved exposure during hepatic resections.
- To assess the efficacy of a right parasternal incision for accessing the root of the hepatic veins.
Main Methods:
- A cohort of 8 patients with poor liver exposure via abdominal incision underwent an additional 5 cm right parasternal skin incision.
- Division of two costal cartilages was performed as part of the modified approach.
- Hepatic resections were performed using this modified access technique.
Main Results:
- The modified parasternal incision provided satisfactory exposure of the operative field in all patients.
- Hepatic resection procedures were successfully completed without thoracotomy.
- No significant intraoperative or postoperative complications were reported.
Conclusions:
- This simple, alternative surgical approach enhances access to the liver, especially for procedures requiring precise isolation of the hepatic veins.
- The technique avoids the need for thoracotomy and operating table rotation, offering a potentially valuable option for specific hepatic resection scenarios.