Evaluation of sternal recumbency for laparoscopic right lateral liver lobectomy through a transdiaphragmatic port in a canine cadaveric population.

Abstract

Objective: To evaluate the feasibility of laparoscopic right lateral liver lobectomy in canine cadavers positioned in sternal recumbency with the aid of an intrathoracic transdiaphragmatic trocar (ITT).

Study design: Ex vivo cadaveric study.

Sample population: Thirteen canine cadavers.

Methods: All cadavers underwent laparoscopic right lateral liver lobectomy in sternal recumbency with ITT placement using either laparoscopic stapling or suture loop equipment. Body weight, total surgical time, liver lobectomy time, and surgical complications were documented. After all liver lobectomies, the livers were harvested, and the weight of the liver lobes and distance to the hilus were recorded.

Results: All liver lobectomies were completed successfully, with two ports placed on the right lateral abdomen and one ITT port. Median total surgical time was 35.5 min (range, 25.1-62.8), median liver lobectomy time was 18.5 min (range, 6.5-42.9), and three cases experienced loss of insufflation due to ITT port failure. A moderate correlation between the weight of the right liver lobe and a longer liver lobectomy time (r_s = .73, p = .0042) was found.

Conclusion: All right lateral liver lobectomies could be performed in sternal recumbency with the placement of an ITT, regardless of body weight. The ITT was useful in all cases for visualization of the hilus.

Clinical significance: Laparoscopic right lateral liver lobectomy is feasible in normal canine patients with no hepatic neoplasia or obvious pathology of different sizes in sternal recumbency. The use of a transdiaphragmatic port can help to evaluate proximity to the hilus and manipulation of the liver lobes.