Laparoscopic Anatomical Segment 2 Segmentectomy by the Glissonian Approach.

Area of Science:

• Hepatobiliary surgery
• Minimally invasive surgical techniques
• Hepatocellular carcinoma (HCC) treatment

Background:

• Segment 2 (S2) hepatocellular carcinoma (HCC) treatment benefits from segment-oriented hepatectomy over left lateral sectionectomy.
• Anatomical resection preserves non-tumor-bearing liver segments.
• Laparoscopic S2 segmentectomy via the Glissonian approach is presented for two HCC cases.

Observation:

• Case 1: 69-year-old female with incidentally detected S2 lesion, diagnosed as HCC via biopsy, Child-Pugh A.
• Case 2: 57-year-old male with hepatitis B, Child-Pugh B cirrhosis, presenting with S2 nodule.
• Both patients underwent laparoscopic anatomical S2 segmentectomy.

Findings:

• Operative times: 240 minutes (Case 1) and 185 minutes (Case 2).
• Intraoperative blood loss: 50 mL (Case 1) and 250 mL (Case 2), no transfusions required.
• Uneventful recovery with discharge on postoperative days 4 and 5.

Implications:

• Demonstrates the feasibility of laparoscopic S2 segmentectomy using the Glissonian approach.
• Highlights a minimally invasive option for S2 HCC, potentially improving outcomes.
• Supports anatomical resection principles in liver surgery for HCC.