Segment 8 Laparoscopic Transection with the use of intercostal trans-diaphragmatic ports - TVASurg

Case Description

The patient is a 64-year-old male, diagnosed with colorectal liver metastasis.
MR scans revealed a 2.5cm dome lesion located in segment 8, showing adhesion to the diaphragm.
Laparoscopic dissection of segment 8 is planned with the use of an ultrasonic dissector and ultrasonic aspirator.
The Pringle maneuver is used to occlude portal and hepatic artery inflow transection.
The patient is positioned in the reverse Trendelenburg position.
At intercoastal level 6, an intercostal port is placed, and the right lung is taken down.
A double-lumen endotracheal tube is used to independently ventilate the left lung.
The adhesion to the diaphragm is taken down and is used as the transdiaphragmatic port.
A balloon trocar is then placed through the intercostal and transdiaphragmatic port.
Superior lateral traction applied to the balloon trocar can enlarge the field of view, and surgical instruments can be fed through the balloon trocar for better access to the posterior margins.
Additional traction is achieved by placing a suture on the resected liver.
This unique approach, using Intercostal Transdiaphragmic trocars (ITT) makes traditionally difficult laparoscopic approaches for small (<4cm) superficial lesions possible by increasing visibility and provide better access.