Laparoscopic hepatic surgery guided by hookwire localization

Due to recent improvements in radiographic technique, computed tomography (CT) occasionally delineates small hepatocellular carcinomas (HCCs) that are invisible with sonography. However, surgery has not been a viable option for these lesions because of the absence of tumor localization. We describe a new technique of preoperative tumor localization using a hookwire to guide laparoscopic surgery for such HCCs. A 68-year-old man with HCC had tumor recurrence after chemoembolization. Two recurrent lesions, 10 mm or less in diameter, located in segment III were demonstrated; not by sonography but by Lipiodol CT. We successfully placed a hookwire into the tumor through a 21-gauge needle under the guidance of CT. The hookwire instrument provided the only clue of tumor location at laparoscopy. The liver around the hookwire was thoroughly coagulated. The postoperative course was uneventful, and the tumor was completely ablated. Preoperative CT-guided hookwire placement is useful to localize and to laparoscopically treat small hepatic lesions.