Feasibility and safety of intercostal trocar-assisted laparoscopic liver resection in posterosuperior segments.

Backgrounds/Aims: Posterosuperior (PS) liver resections present technical challenges, and there is limited evidence on the use of intercostal (IC) trocars. This study aims to describe our technique and assess its feasibility and safety in a series of patients undergoing laparoscopic liver resection (LLR). Methods: We conducted a single-center retrospective analysis between 2022 to 2025. Among 40 patients who underwent LLR of PS segments, an accessory right IC 5-mm port was utilized in 8 cases. Outcomes evaluated included intraoperative complications, conversion rates, blood loss, operative time, length of hospital stay, 90-day morbidity/mortality, and margin status. Results: Eight patients (62.5% female; mean age 50.5 ± 21.39 years; median body mass index 22.27 [IQR 20.8-29.81]) underwent LLR utilizing a single 5-mm IC port. The indications for surgery were liver adenoma (n = 3), colorectal liver metastases (n = 3), neuroendocrine tumor metastasis (n = 1), and hepatolithiasis (n = 1). The mean operative time was 422.5 ± 127.56 minutes, with a mean blood loss of 153.75 ± 58.29 mL, and no transfusions were necessary. There were no intraoperative complications, conversions, or deaths. All patients achieved negative margins (mean 10.25 ± 1.5 mm). The mean length of hospital stay was 4.5 ± 0.93 days, and the 90-day morbidity rate was 0%. Conclusions: The use of a small IC port in LLR for PS segments is both feasible and safe, offering improved exposure without increasing morbidity. Larger, multicenter prospective studies are needed to validate these findings and to standardize indications, port size, and placement.