Abstract
Background:
When hepatocellular carcinoma (HCC) was located in segment 2 (S2), anatomical resection offers a better oncologic outcome as it removes all the portal pedicles and parenchyma potentially involved by the tumor. Moreover, monosegmentectomy has the additional advantage of preserving the nontumor-bearing parenchyma. This is especially important in patients with chronic liver disease and limited liver remnant volume. Herein, we present a case of laparoscopic anatomical S2 segmentectomy by the glissonian approach.
Materials and Methods:
A 69-year-old woman was admitted for an incidentally detected liver nodule on abdominal ultrasonography for systemic surveillance for her breast cancer. The preoperative liver function was Child-Pugh class A. Abdominal CT showed a 2 cm low attenuating lesion in S2. Contrast MRI showed the same lesion with features more suggestive of HCC. In view of the inconclusive imaging findings, a needle biopsy was performed and it confirmed the diagnosis of HCC. Laparoscopic anatomical S2 segmentectomy was contemplated. Cavitron ultrasonic surgical aspirator (CUSA) was used to dissect and isolate the S2 glissonian pedicle, which was then temporarily clamped. The ischemic demarcation of S2 was marked. Parenchymal transection was performed with ultrasonic shears and CUSA along the ischemic line, exposing the left hepatic vein. Upon completion of the parenchymal transection, the remaining S2 glissonian pedicle was divided between clips.
Results:
The operative time was 240 minutes. The estimated intraoperative blood loss was 50 mL and no transfusion was necessary. The patient was discharged on the fourth postoperative day without any complications. Pathology analysis of the resected specimen showed HCC with a 4 mm resection margin. No adjuvant therapy was given. Upon follow-up at 16 months after the operation, the alpha fetal protein level was normal (2.8 IU/mL) and the CT scan showed no evidence of recurrence.
Conclusion:
This video presentation showed the safety and feasibility of laparoscopic S2 segmentectomy by the glissonian approach. It has the benefit of preserving the nontumor-bearing parenchyma and this anatomical resection offers a better oncologic outcome.
Runtime of video: 7 mins
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