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Updated: Sep 27, 2026
Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach
Published on: August 8, 2025
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
Background:
Although hepatic resections are performed with various access approaches according to the location of the tumor, the extent of resection and patient's physical constitution, the exposure of the root of the hepatic veins is not optimal in some patients by any conventional incision.
Methods:
An additional 5 cm of right parasternal skin incision followed by division of two costal cartilages was performed in 8 patients, which demonstrated poor exposure of the upper part of the liver by abdominal incision.
Results:
In all cases, satisfactory exposure of the operative area was obtained without thoracotomy, and hepatic resection procedure was carried out without significant events.
Conclusions:
This simple technique without necessitating rotation of the operating table may be useful as an alternative method of access to the liver especially when fine isolation around the root of the hepatic veins is required.
