Liver resection, left lateral, laparoscopic

Through a skin incision two to three fingerbreadths above the navel, insertion of the Veress needle and pressure-controlled creation of the pneumoperitoneum up to 13 mm Hg. Insertion of a 10 mm safety trocar. Introduction of the optics and exploration of the upper abdomen: there is an impression of an inflammatory conglomerate tumor; the left liver lobe is adhered cranially to the diaphragm and caudally to the stomach and greater omentum.

Under endoscopic view insertion of a 12 mm trocar in the left upper abdomen as well as a 5 mm trocar at the same height in the right upper abdomen. The Lig. teres hepatis and the Lig. falciforme hepatis are divided close to the abdominal wall using the UltraCision Harmonic Scalpel®.

The mobilization of the left liver lobe is significantly hindered due to inflammatory changes. In this process, adhesions to the diaphragm up to the mobilization of the left hepatic vein must be released step by step. Due to the extensive adhesions, the triangular ligament cannot be identified as such. The stomach and the lesser omentum are also extensively adherent to the visceral surface of the left liver lobe. Detachment of the stomach from the undersurface of the liver with mobilization of the hepatic hilum and opening of the lesser omentum up to the diaphragm.