A case of laparoscopic hepatectomy for recurrent hepatocellular carcinoma after two previous open hepatectomies.

Abstract

Introduction: Laparoscopic hepatectomy after open hepatectomy may be relatively easy depending on the positions of the tumor and the previous hepatectomy site. When adhesions are evident, however, laparotomy may be inevitable. We performed laparoscopic liver S5 partial resection for a patient with recurrent hepatocellular carcinoma(HCC) in S5 after having undergone open hepatectomy twice before and transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) multiple times during the previous 12 years. The video shows the procedure. Method: Patient: A man in his 70s. HPI: Liver S7 segmentectomy had been performed for HCC in 2006. HCC recurred in S1, and liver S1 partial resection was performed in 2009. Thereafter, TACE and RFA were performed four times each until 2018. The posterior branch of the portal vein was narrowed because of RFA. Hepatoma recurred at the inferior border of S5 of the liver in 2018. Laboratory data: HCV antibody positive, PLT 78,000/μl, ICGR15’ 18.0%. Result: Operative procedure: Left semi-lateral position. First, three ports were placed in the lower abdomen for adhesiolysis. After adhesiotomy of the greater omentum and the ascending colon was performed toward the liver, detachment of the descending part of the duodenum proceeded in a caudocranial direction. When the inferior surface of the liver was reached, the target liver tumor was confirmed with intraoperative ultrasonography. Several ports were added, and partial resection of S5 of the liver was performed. Conclusion: Even after two previous open hepatectomies, laparoscopic resection is possible, providing that preoperative image simulation and thorough adhesiotomy of the adjacent organs are performed, and laparoscopic resection should be attempted.