Totally laparoscopic central bisectionectomy for hepatocellular carcinoma

Area of Science:

• Hepatobiliary surgery
• Minimally invasive surgical techniques
• Surgical oncology

Background:

• Central bisectionectomy, involving liver segments 4, 5, and 8, is a complex procedure due to its dual transection planes.
• The laparoscopic approach for this specific liver resection has been infrequently documented.
• Hepatocellular carcinoma (HCC) located centrally, particularly near major hepatic veins, presents significant surgical challenges.

Observation:

• A 49-year-old male patient with centrally located HCC abutting the middle hepatic vein underwent a totally laparoscopic central bisectionectomy.
• The procedure utilized five trocars with the patient in the lithotomy position.
• Operative time was 430 minutes with an estimated blood loss of 800 mL; no blood transfusion was required.

Findings:

• Postoperative pathology confirmed HCC with a 1-cm clear resection margin.
• The patient experienced no significant complications and was discharged on postoperative day 13.
• This case highlights successful oncologic resection via a minimally invasive technique.

Implications:

• The totally laparoscopic central bisectionectomy is a feasible and safe option for treating selected cases of centrally located HCC.
• This approach may offer advantages in terms of recovery and reduced morbidity compared to open surgery.
• Further studies are warranted to establish the long-term outcomes and expand the application of this technique.