Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8

Performing laparoscopic liver resection for lesions located in segment 7 and 8 is technically difficult, as the operative field is far from the conventional trocar site, and the liver impedes free motion of the laparoscopic instrument. Inserting the port through the intercostal space (ICS) may facilitate liver resection for these lesions. From January 2012 to July 2013, five patients (four men and one woman) underwent laparoscopic S7 or 8 segmentectomy for liver metastasis and hepatocellular carcinoma (HCC). Ports were inserted at the 7th and 9th ICS, respectively, in addition to conventional abdominal ports. The mean age was 58 +/- 10 (45-74) years; operation time, 197 +/- 68 (110-300) minutes; blood loss, 161 +/- 138 (40-320) ml; and length of hospital stay, 7 +/- 3 (4-12) days. Pathologic findings revealed three, one, and one case(s) of colon cancer metastasis, breast cancer metastasis, and HCC, respectively. The mean tumor size and tumor-free margin were 2.2 +/- 1.1 cm and 5.8 +/- 1.9 mm, respectively. There were no postoperative complications. Laparoscopic liver resection using intercostal trocars could be a useful method for tumors located in segments 7 and 8 of the liver in selected patients.