Laparoscopic right hepatectomy for fibrolamellar HCC

Abstract

Background: We present the case of a 27-yo female presenting with asymptomatic 8 cm tumor in liver segment 7. Liver function and AFP were normal, no viral infection was detected. Percutaneous biopsy showed hepatocellular carcinoma. Methods: The patient was placed in a partial left lateral decubitus. We used three 12mm and two 5 mm trocars. The optical trocar was placed on the mid-axillary line. Abdominal cavity exploration confirmed a normal liver with no signs of cirrhosis. The tumor was only visible at laparoscopic ultrasound. Results: Right portal vein and right hepatic artery were selectively divided extra-parenchymally. The hepatectomy was performed without prior liver mobilization. The parenchymal transection was pursued along the middle hepatic vein with CUSA and Thunderbeat. Hemostasis and biliostasis were achieved with Hem-o-loks. Right hepatic duct was divided intraparenchymally. Once hepatic transection was completed and inferior vena cava exposed, accessory right hepatic veins were selectively controlled with Hem-o-loks. Right hepatic vein was isolated and divided using a linear stapler. The surgical specimen was extracted through a Pfannenstiel incision. Intermittent hepatic pedicle clamping was used for 27 minutes. Blood loss was 350 mL, no intra or post-operative blood transfusion was needed. Conclusion: Pathological report showed a well differentiated fibrolamellar HCC with a R0 resection developed on a normal liver. Post-operative course was uneventful. Patient was discharged on 6th postoperative day.