Laparoscopic posterior sectionectomy for HCC

Abstract

Background: We present the case of a 56-yo female with HCC on HCV cirrhosis. The lesion is located at the junction of segments 6 and 7. The patient is Child-Pugh A, MELD 8, AFP 6.6 ng/ml. Methods: The patient was placed in a partial left lateral decubitus. We used three 12mm and two 5 mm trocars. The optical trocar is placed on the mid-axillary line. Results: Abdominal cavity exploration confirmed macronodular cirrhosis. The lesion in the posterior sector was confirmed at intra-operative ultrasound. After cholecystectomy a tape was passed around the hepatic pedicle for the Pringle maneuver. The right posterior pedicle was dissected and clamped extraparenchymally in order to define the transection line which was marked with monopolar cautery and Thunderbeat. The liver parenchyma was partially opened at the level of right posterior pedicle in order to facilitate its control and division using a linear stapler. The parenchymal transection was pursued along the right hepatic vein with CUSA and Thunderbeat. Hemostasis and biliostasis was achieved with Hem-o-loks. Intermittent hepatic pedicle clamping was used for 105 minutes. Blood loss were 200 cc, no intra-operative blood transfusion were needed. Conclusion: Pathological report showed a well differentiated HCC with a R0 resection.Post-operative course was marked by transient ascetic decompensation. Patient is alive without signs of recurrence 12 months after surgery.