Laparoscopic anatomical resection of segment 7 and segment 8 when right hepatic vein reconstruction was not necessary

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Introduction: For a huge liver cancer in segment 7 and 8 with right hepatic vein (RHV) involvement, some patients with large inferior right hepatic veins (IRHV) can avoid complex vascular reconstruction after en bloc resection of segment 7 and 8 and RHV. In such a situation, safe laparoscopic surgery becomes possible. Method: This is a case report about a 9.7cm HCC in segment 7 and 8 with RHV involvement inside liver parenchyma. This patient had at least two large IRHV in computed tomography. In this operation, I transected the parenchyma along the middle hepatic vein first to create a midline plane. Then the right major Glisson's pedicle and S8 pedicle next to it were exposed in parenchyma from the opened liver midline. After S8 pedicle was transected, I advanced the dissection between segment 5 and 8 ( the transverse plane) and cut the tributaries and the dominant tract of RHV in this plane. The surface of a large IRHV was exposed in this transverse plane too. In another direction, I deepened the midline plane to expose IVC superior to the liver hilum. The root of RHV was ligated and cut from IVC. The root of the large IRHV on IVC was exposed in this midline plane between RHV and liver hilum. So, the large IRHV was preserved in both midline and transverse plane. I further advanced the parenchyma dissection to cross the surface of IRHV, and then deepened the dissection dorsally to separate the segment 7 & 6. Triangular and coronary ligaments were cut at last. Result: Hepatopetal portal flows were all preserved. Conclusion: In summary, this laparoscopic operation was performed using caudal to cranial (midline), medial to lateral ( between S5-S8), and ventral to dorsal (between S6-S7) approach. There was not any dissection between IVC and segment 1 right portion behind liver hilum.