Laparoscopic hepatic resection for metastatic recurrence on hepatectomy margin: a novel traction technique using previously placed locking clips

Recurrent hepatic metastases at the resection margin following laparoscopic hepatectomy present technical challenges due to adhesions and altered anatomy. We describe an innovative traction technique using locking clips to facilitate safe re-resection. A 65-year-old patient with colorectal liver metastasis in segment 6 underwent laparoscopic hepatectomy. Three years post-operatively, imaging revealed recurrence at the hepatectomy margin. We describe a novel technique utilizing previously placed locking clips from the initial surgery as traction elements to provide optimal exposure during laparoscopic re-resection. The technique involves repurposing locking clips that were placed during the initial hepatectomy for hemostasis, using them as traction elements to create controlled manipulation of liver segments, allowing safe dissection and optimal visualization of the recurrent lesion, particularly valuable in peripheral hepatectomies. This innovative technique of repurposing previously placed locking clips as traction elements represents a valuable addition to the laparoscopic hepatobiliary surgeon's armamentarium for managing recurrent hepatic metastases.