Optimal indications for an intercostal port for the superior segments in laparoscopic partial liver resection

Intercostal port is useful for the superior segments in laparoscopic liver resection, but optimal indications for its use remain unclear. This study analyzed the surgical outcomes in patients undergoing laparoscopic partial liver resection for superior segments to determine the optimal indications.

A total of 30 cases of laparoscopic partial liver resection for superior segments were retrospectively reviewed. First, comparison of cases according to use of the intercostal port was performed. Second, cases were classified into two groups according to the branch of the hepatic vein in the superior segments: superior-ventral group (S4a/S8vent: Svent group, n = 18) and superior-dorsal group (S7/S8dor: Sdor group: n = 12). The surgical outcomes were then compared to assess the performance of intercostal ports.

No differences in surgical outcomes were observed between patients with or without intercostal port. In this series, no complication due to the intercostal port, and no major complication were observed. In the comparison between Svent and Sdor, similar values of the operation time (Svent: 275 minutes vs Sdor: 316 minutes, P = .161) and blood loss (Svent: 30 mL vs Sdor: 17 mL, P = .718) were observed in both groups. The tumor size tended to be smaller in Sdor (Svent: 20 mm vs Sdor: 17 mm, P = .018), but use of the intercostal port was significantly more frequent in Sdor (58%) compared to Svent (33%) (P < .001).

The lesion located at Sdor or that close to this location was considered as optimal indication for placement of intercostal port in patients undergoing laparoscopic partial liver resection.