Laparoscopic right hemihepatectomy for hepatocellular carcinoma.

Abstract

Although laparoscopic liver resection has been widely adopted, laparoscopic right hepatectomy remains a challenging procedure. This video shows the relevant technical maneuvers in each step of a total laparoscopic right hepatectomy. A 47-year-old man was admitted for evaluation of an incidental hepatic mass noted on a health screening test. Two months ago, transarterical chemoembolization was performed for a 3.5-cm hepatocellular carcinoma (HCC), which was located in S7-8; a follow-up abdominal computed tomography (CT) revealed incomplete necrosis of the HCC. The laboratory studies were positive for hepatitis B viral markers and a normal level of alpha-fetoprotein level. The preoperative liver function was Child-Pugh class A. A laparoscopic right hemihepatectomy was performed for this lesion. An anatomic resection of the right liver was possible with selective control of a Glissonian pedicle to the right liver. The operating time was 305 min. The estimated intraoperative blood loss was approximately 300 ml; an intraoperative transfusion was not necessary. The postoperative pathology confirmed a 3.5 x 2.8 x 2.7 cm HCC with safe margins. The patient was discharged on the 9th postoperative day without any postoperative complications. A laparoscopic right hepatectomy is feasible for patients with HCC, although the operative technique is still demanding.