Laparoscopic resection of segment 4 and ventral area of anterior section in cirrhotic liver

Abstract

In this video, I will describe the laparoscopic procedure where the hepatic territory supplied by the Glisson pedicles to the segment 4 and the ventral branches of the right anterior Glisson pedicle is resected. A 48 years old male patient presented with two HCC's. Chronic hepatits B was diagnosed 20 years ago. 8 months ago a hypoechoic lesion (1.5 cm) was identified in right liver. No treatment was given. On follow CT scan, 2 HCC's were identified. One tumor was 1.8 cm in size and located at segment 5-6, 2 cm deep from the liver surface. The other tumor was 1.5 cm in size and located at liver hilum, in between the left and right anterior Glisson pedicles and in proximity to the middle hepatic vein. The level of AFP was 3.7 ng/mL and PIVKA II 126 mAU/mL. E was 10.4 kPa on fibroscan. For the sake of preservation of liver volume, the former lesion was ablated with radiofrequency energy before the surgery. And for the latter lesion, laparoscopic resection of segment 4 and ventral area of anterior section was performed. The operation took 390 minutes. No blood product was given perioperatively. The patient was discharged 6 days after the operation without any complication. He is now tumor free 8 months after the operation. Laparoscopic resection of segment 4 and ventral area of anterior section in cirrhotic liver can be performed safely and anatomically. Tumor adherent to the middle hepatic vein is a good indication for this parenchyma-sparing resection.