A CASE OF VIDEO-ASSISTED THORACOSCOPIC SURGERY—HEPATECTOMY (VATS-H) FOR LIVER NEOPLASM WITH A PREOPERATIVE THREE-DIMENSIONAL VISUALIZATION SYSTEM

Abstract

We demonstrate here a novel technique of video-assisted thoracoscopic surgery-hepatectomy (VATS-H) for a liver tumor located in the subdiaphragmatic area based on a preoperative three-dimensional visualization system. Computed tomography study was performed for a 64-year-old HCC male patient; liver structures were segmented as viewed by the preoperative three-dimensional visualization system (SYNAPSE VINCENT: Fujifilm Medical, Tokyo, Japan). Moreover, the virtual thoracoscopy was used to indicate the accurate port position for hepatectomy. The surgeon planned the resection preoperatively and read the resection mapping as a reference guidance during the procedure. Three cases of VATS-H were performed for liver neoplasm. Using intraoperative thoracoscopic sonography (IOTS), the portion of the diaphragm located just above the tumor was cut and opened using Laparoscopic Coagulating Shears. IOTS was performed on the liver surface, and the margin of tumor was marked by electric cautery. For the resection of liver, bipolar radiofrequency device (RFA, Habib 4x^™, Rita, USA) was used for precoagulation before transection of liver and coagulation of liver parenchyma during the transection of the liver. The operating time was 140 minutes. The operative blood loss was 30g. To date, no complication after surgery had occurred. VATS-H under the guidance of the preoperative three-dimensional visualization system was useful for a liver tumor located in the subdiaphragmatic area.