Laparoscopic anatomic monosegmentectomy of hepatocellular carcinoma of the right hepatic lobe

Laparoscopic resection of lesions at right hepatic lobe is considered difficult. The objective of this study is to describe our institutional techniques of laparoscopic anatomic monosegment resection of hepatocellular carcinoma (HCC) in all segments of the right lobe.

Patients with deep-seated solitary tumors in a single segment of right hepatic lobe were considered for laparoscopic anatomic monosegment resection when the planned transection plane could give a 1-cm resection margin from the adjacent nontumour segments. The purpose of this surgery design is to achieve an oncologic resection while preserving the maximal volume of liver parenchyma.

Five patients underwent successful laparoscopic anatomic monosegmentectomy with no conversion to open. They were all male with a solitary HCC size ranging from 2 to 3 cm. Cirrhosis was present in 2 (40%) patients. The mean blood loss was 676 mL (range, 280 to 1200 mL) and perioperative blood transfusion was not required. There was no operative mortality or morbidity, and no recurrences were noted.

Laparoscopic monosegmentectomy is feasible and safe in selected patients with HCC. It provides the benefit of maximal preservation of nontumour liver parenchyma, while oncologic resection is secured.