Right hepatic lobectomy with thoracotomy: a description (with video)

To describe surgical techniques and results of right hepatic lobectomy (RHL) with thoracotomy. This procedure consists of laparotomy and thoracotomy, cholecystectomy, division of the right hepatic artery and right portal vein, mobilization of the liver, division of the right hepatic vein, transection of the liver parenchyma, and division of the right hepatic duct. Thoracotomy allows effective retraction of the costal arch, creating a better operative field and widening the working space. Between April 2000 and May 2011, RHL, excluding RHL with partial resection of the liver, with bile duct resection, and with combined resection of other organs, was performed in 62 patients. Thoracotomy was employed in 55 patients, but not in the remaining 7. There were no statistically significant differences in age, ICG15, blood loss, Pringle time, or morbidity between the two groups, but there was a significant inter-group difference in operation time. There was no postoperative mortality in either of the groups. Although RHL with thoracotomy requires a longer operation time than RHL without thoracotomy, a thoraco-abdominal approach offers a greater degree of safety, particularly in patients with massive tumors, or tumors invading the diaphragm, without any increase in morbidity or mortality.