Laparoscopic Right Hemihepatectomy for Hepatocellular Carcinoma

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.Yoon YS, 2009, J LAPAROENDOSC ADV S, V19, P653, DOI 10.1089/lap.2009.0012Dagher I, 2009, AM J SURG, V198, P173, DOI 10.1016/j.amjsurg.2008.09.015Han HS, 2009, J HEPATO-BILIARY-PAN, V16, P427, DOI 10.1007/s00534-009-0118-2NGUYEN KT, 2009, ANN SURG, V250, P831Cho JY, 2009, ARCH SURG-CHICAGO, V144, P25DAGHER I, 2009, ANN SURG, V250, P856Dagher I, 2008, J AM COLL SURGEONS, V206, P756, DOI 10.1016/j.jamcollsurg.2007.09.012Abu Hilal M, 2008, DIGEST SURG, V25, P305, DOI 10.1159/000155222MACHADO MA, 2008, AM J SURG, V196, pE38Koffron AJ, 2007, ANN SURG, V246, P385, DOI 10.1097/SLA.0b013e318146996cChang S, 2007, BRIT J SURG, V94, P58, DOI 10.1002/bjs.5562KOFFRON AJ, 2007, ANN SURG, V246, P392Yoon YS, 2006, J LAPAROENDOSC ADV S, V16, P274