Figure 6.

Scheme of open liver resection (A), laparoscopic liver resection [regular caudal approach, (B)], laparoscopic liver resection [lateral approach, (C)] and thoracoscopic liver resection (D). Red arrows indicate the directions of view and manipulation in each approach. (A) In the open approach, the subcostal cage containing the liver is opened with a large subcostal incision and instruments are used to lift the costal arch, after which the liver is dissected and mobilized (lifted) from the retroperitoneum; (B) In the regular laparoscopic caudal approach, the laparoscope and forceps are placed into the subcostal cage from the caudal direction, and the surgery is performed with minimal alteration and destruction of the associated structures; (C) In the laparoscopic lateral approach, the intercostal (transdiaphragmatic) ports combined with total mobilization of the liver from the retroperitoneum can allow the direct lateral approach into the cage and to the posterosuperior tumors; (D) Thoracoscopic approach is employed for lesions in segment 8, with direct exposure of the tumor into the pleural cavity upon incision on the diaphragm adjacent to the tumor, with the endoscope placed in the pleural cavity. From Morise and Wakabayashi (49).