Totally Anatomic Laparoscopic Right Anterior Sectionectomy

Abstract

Although laparoscopic major hepatectomy has frequently been performed, laparoscopic right anterior sectionectomy (Lap-RAS) has rarely been reported. In this report, we present three cases of totally Lap-RAS and the relevant technical maneuvers in each step of this procedure. Case 1 was that of a 40-year-old man who was admitted with abnormal intrahepatic bile duct dilatation containing multiple intrahepatic duct stones in S8. Preoperative imaging studies revealed the possibility of localized Caroli's disease. Case 2 was that of a 63-year-old woman who was admitted with hepatic masses detected by follow-up computed tomography scan for breast cancer. At first, these masses were suspected to be hepatic metastasis from breast cancer for which she had undergone right lumpectomy with axillary lymph node dissection, 1 year before. However, subsequent ultrasonographic biopsy showed a pathologic finding of hepatocellular carcinoma. Case 3 was that of a 54-year-old woman who was admitted for a hepatic mass noted on a health screening test, 2 weeks before. Imaging studies showed that a 2.7-cm-sized single mass was located in the border of S5 and S8, and the laboratory studies were positive for hepatitis B viral markers. Operative times for Cases 1, 2, and 3 were 680, 600, and 540 minutes, respectively, and estimated blood loss during operations was 120, 400, and 500 mL, respectively. Intraoperative transfusion was not necessary. Patients 1, 2, and 3 were discharged on postoperative Days 30, 7, and 8, respectively. Lap-RAS is feasible for selected patients with benign and malignant liver disease, although the operative technique is still demanding.