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Modified Thoracoscopic Hepatectomy For Segment VIII: A Case Report.

Hongyu Li¹, Yonggang Wei, Bo Li

¹From the Department of Pancreatic Surgery (HL BP), West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; and Department of Liver Surgery (YW, BL), West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

|June 4, 2016

Summary

A modified thoracoscopic hepatectomy (TH) is presented for malignant liver tumors, overcoming limitations of intraoperative ultrasonography (IUSO) in total TH. This two-step approach is feasible for tumors in segments VII or VIII.

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Area of Science:

Hepatobiliary Surgery
Minimally Invasive Oncologic Procedures
Thoracic Surgery

Background:

Total thoracoscopic hepatectomy (TH) is challenging for malignant liver tumors due to intraoperative ultrasonography (IUSO) limitations for whole-liver metastasis assessment.
Standard TH may not be suitable for all malignant liver tumor cases requiring comprehensive intraoperative imaging.

Observation:

A 26-year-old male with hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) in segment VIII underwent a novel two-step modified TH.
The procedure involved supine positioning for initial IUSO and Pringle maneuver, followed by a left-lateral position for thoracoscopic resection.
IUSO was utilized twice to confirm tumor location and rule out intrahepatic metastasis.

Findings:

The modified TH successfully resected a segment VIII malignant liver tumor with minimal blood loss (30 mL) and a 260-minute operative time.

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The patient was discharged on postoperative day 5 with normal liver function and no complications.

The two-step modified TH allows for effective IUSO and tumor resection in challenging locations.

Implications:

This modified TH technique is technically feasible and safe for malignant liver tumors in segments VII or VIII.
It offers a viable minimally invasive surgical option for selected patients, addressing the limitations of conventional total TH.
This approach expands the application of thoracoscopic surgery for complex liver malignancies.