Laparoscopy-assisted hepatectomy for giant hepatocellular carcinoma

The indications for laparoscopic hepatectomy were limited; generally, tumors smaller than 5 cm serve as proper indications. Here, we initially report on a patient with huge hepatocellular carcinoma (HCC) sized 15 cm in the left lateral segment who was treated by laparoscopy-assisted technique.

3 trocars were inserted under pneumoperitoneum. The attached ligament was divided and mobilization of the liver could be performed with laparoscopic coagulating system. In accomplishing this maneuver, upper median skin incision of 7 cm was made. The left lateral segment was exposed to be lifted up the tape around the liver. Dissecting sealer (DS30) was used for transection of the liver parenchyma. The relatively large branched vessels and ducts were ligated and transected by direct view from upper median 7-cm incision. Segment 2 and 3 Glisson's sheaths and left hepatic vein were divided using an endolinear stapler. A Hand Port system laparotomy device was installed under pneumoperitoneum, the resected liver maneuvered into a suitable sized plastic bag by endoscopic view. Extraction of the undivided specimen was performed, thus enabling histologic review. Operation time was 170 minutes and operative blood loss was 100 g. The tumor was a 15x12x9 cm in size. Oral intake and ambulation was on the first day; 7 days after the surgery patient was discharged with an uneventful postoperative course. Because of the specific characteristics of HCCs such as their high recurrence rate, the most important goals in HCC treatment are curability and minimal invasiveness. Laparoscopic hepatectomy in this case is beneficial for the patients' quality of life as a minimally invasive operation.