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Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure

Abstract

Background

Laparoscopic hepatectomy is a common procedure that has been reported frequently [13]. However, laparoscopic resection of tumors located in hepatic segments 5 and/or 8 remains a technically difficult procedure as it requires two transection planes [4]. Furthermore, there are a greater number of hepatic vein and glissonian pedicle branches that require a division as compared to other hepatectomy operations. In this report, we present a pure laparoscopic right anterior sectionectomy (RAS) for hepatocellular carcinoma (HCC).

Methods

Preoperative imaging showed HCC (3 cm × 4 cm) in segment 5 [5]. After selective anterior segment inflow occlusion, transection lines were demarcated. Complete Pringle maneuver was performed for 15 min intervals five times during hepatic parenchymal transection. The Cavitron Ultrasonic Surgical Aspirator was used for the transection of the hepatic tissue. Small hepatic vein branches along the middle and right hepatic veins and small glissonian pedicles were clipped, sealed and divided with EnSEAL (TM) (Ethicon). iDrive (TM) Ultra Powered Stapling device (Medtronic) was used for the division of tertiary glissonian pedicles. Hanging maneuver was performed for transection of remaining liver parenchyma after complete division of hepatic venous branches. The specimen was removed through the lower abdominal transverse incision using the endocatch bag. Jackson-Pratt drain was left in the operative field. All work was performed with IRB approval.

Results

Pure laparoscopic RAS for HCC was performed successfully without intraoperative complications or transfusions. The operation time was 300 min, and the estimated blood loss was <200 ml. On postoperative day 5, computed tomography scan showed well-perfused hepatic parenchyma. Pathology specimen confirmed 3.2 cm × 3 cm × 2.2 cm HCC without involvement of surgical resection margins. The patient was discharged on postoperative day 7 without complications.

Conclusions

Pure laparoscopic RAS is a feasible operative procedure in patients with tumors located in hepatic segments 5/8.

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References

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    Kim KH et al (2006) Clinical analysis of right anterior segmentectomy for hepatic malignancy. Hepatogastroenterology 53(72):836–839

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    Yoon SY et al (2015) Oncological and surgical results of laparoscopic versus open liver resection for HCC less than 5 cm: case-matched analysis. Surg Endosc Other Interv Tech 29(9):2628–2634

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Author information

Correspondence to Ki-Hun Kim.

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Disclosures

Drs. Varvara A. Kirchner, Ki-Hun Kim, Seok-Hwan Kim and Mr. Sang-Kyung Lee have no conflicts of interest or financial ties to disclose.

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Kirchner, V.A., Kim, K., Kim, S. et al. Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure. Surg Endosc 31, 3349–3350 (2017) doi:10.1007/s00464-016-5349-0

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Keywords

  • Laparoscopic hepatectomy
  • Right anterior sectionectomy
  • Hepatocellular carcinoma