2.2. Surgical procedure
Laparoscopic surgery was performed by 4 inserted ports along with the
open Hasson procedure, as follows: 12-mm port for the scope; umbilical
position, 5-mm port; sub xiphoid for the operator’s right hand, right
flank region for the operator’s left hand and right upper abdomen for
the assistant (Fig. 2A). To obtain adequate visibility of the inferior
space of the liver, the round ligament of the liver was retracted with
2-0 silk using a 19-G percutaneous loop needle insertion device. In
addition, the snake liver retractor was inserted through the trocar of
the right upper abdomen to elevate the right lobe of the liver [7].
The tumor, located at the right side of the duodenum, was carefully
dissected in a sharp and blunt manner and never directly grasped with
forceps to prevent rupture and spillage of the tumor (Fig. 2B). The
feeding artery and drainage vein were coagulated and divided using the
vessel sealing system (Fig. 2C). The tumor was completely excised
without rupture or spillage. The umbilical wound for the optical port
was extended, and the tumor was extracted using an endsurgical bag. The
operative time was 149 minutes, with 2-ml blood loss.