Laparoscopic Anatomical S5 Segmentectomy by the Glissonian Approach

Abstract

Nonanatomical tumorectomy that includes the lesion is commonly performed for the malignant tumor located at the segment 5 (S5) of the liver. Although anatomical resection has theoretical advantages, anatomical S5 segmentectomy is a technically demanding procedure, and it becomes more difficult if it is performed laparoscopically. We report here on laparoscopic anatomical S5 segmentectomy using the glissonian approach. A 53-year-old man was admitted for a hepatic mass that was incidentally found on a health screening test. The laboratory studies show negativity for viral markers and a normal level of alpha-fetoprotein level. The preoperative liver function was Child-Pugh class A. Abdominal computed tomography revealed a 5.2-cm mass that was located in segment 5. The lesion shows enhancement on the arterial phase, which was washed out on the delayed phase. Laparoscopic anatomical S5 segmentectomy was planned with the preoperative diagnosis of hepatocellular carcinoma. The operative time was 300 minutes. The estimated intraoperative blood loss was about 300 mL, and an intraoperative transfusion was not necessary. The postoperative pathology confirmed a 6.0 × 4.5 × 3.0-cm neuroendocrine carcinoma with a cholangiocarcinoma component. The patient was discharged on the 9th postoperative day without any complications. This case shows the feasibility of performing laparoscopic anatomical S5 segmentectomy.