Introduction : This study aimed to evaluate the utility and safety of intercostal port with the left lateral position for laparoscopic partial resection of hepatic tumors in the right posterior section.

Methods : A total of 21 patients were included in this study. All surgical procedures were performed in the left lateral position. Intercostal port was inserted at the 8th to 10th intercostal space with inspecting the movement of diaphragm, not to penetrate the lung. Parenchymal transection was performed with the intermittent Pringle maneuver using the bulldog clamp. After transection, intercostal port was closed by an Endostitch device (Covidien, Mansfield, MA) concurrently with aspiration of intrapleural air for preventing pneumothorax. Perioperative characteristics were evaluated.

Results : The surgical indications were hepatocellular carcinoma in 14 patients and colorectal cancer liver metastasis in 4 patients. Median operation time was 190 minutes (100–355), and no patients received transfusion. Median tumor size was 2.1 cm (0.8–3.6), and R0 resection was achieved in all patients. In this cohort, pulmonary complications including pneumothorax did not occur, and only one patient experienced complication of Clavien–Dindo grade IIIA; irrelevant to the intercostal port. Median hospital stay was 6 days (5–37).

Conclusions : Laparoscopic liver resection using the intercostal port in the left decubitus position could be a safe and feasible approach for tumors in the posterior section without causing serious complications.