Laparoscopic hepatectomy for segments I, IV, V and VIII.

BACKGROUND: According to difficulty scoring system [1], laparoscopic hepatectomy (LH) for caudate lobe and middle segments should be considered as the most difficult case. We here report the first case of LH for segments I, IV, V and VIII in China.

METHODS: The patient was a 31-year-old man without hepatitis history. Preoperative MRI revealed a 5.0 cm × 5.2 cm mass located in the paracaval portion. Preoperative liver function tests and tumor markers were normal. Preoperative diagnose was hepatic adenoma. Informed consents were obtained from the patient himself and his parents. The West China Hospital administration and the ethics committee authorized the surgery.

RESULTS: After cholecystectomy, the right hemi-liver was mobilized. Intraoperative ultrasonography was used to locate the tumor precisely. A rubber tube was placed through the tunnel between liver and vena cava for the preparation of Hanging maneuver. Parenchymal transection started from segment IV under Pringle maneuver. The superficial of liver was dissected by ultrasonic shears, and the deeper tissue was dissected by ultrasonic aspirator. The hemi-hepatic vascular inflow occlusion was then adopted after dissection of hepatic hilum. The caudate lobe was completely separated from the left lateral lobe and the right posterior lobe. The root of middle hepatic vein and the right anterior Glisson's branch were transected by linear stapler. The cephalic transection was carefully performed along the root of right hepatic vein. Finally, the transection was completed after an exposure of right and left hepatic vein and vena cava, as well as hepatic hilum. The specimen was put into a retrieval bag and removed from suprapubic incision. The operation time was 410 min, and blood loss was 300 ml. Hepatic adenoma was postoperatively diagnosed (Table 1). The postoperative course was uneventful for the patient.

CONCLUSION: LH for segments I, IV, V and VIII can be safely performed in selected patient in experienced center.