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 To obtain adequate visibility of the inferior space of the liver, the round ligament of the liver was retracted with 2-0 silk using a 19-G percutaneous loop needle insertion device.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.