Background Anatomical Resection of segment (S) 7 is considered as one of the most challenges for laparoscopic hepatectomy.
Methods A 57-year-old male presented to the hospital with liver masses for a week without obvious symptoms,the laboratory examinations showed that alpha-fetoprotein(AFP) increase significantly and with chronic hepatitis B virus (HBV)infection.Preoperative abdominal enhanced CT scan showed tumors located in S2 and S7, About 5.4cm*4.8cm and 4.8cm*4.1cm respectively.The video demonstrates a case of laparoscopic anatomical hepatectomy of S7 by dorsal approach combined with right hepatic vein first procedure.
Results After left lateral segmentectomy (hepatic segments II/III), the patient's left lateral position was uesd to facilitate the procedure of the S7 hepatectomy.The Rouviere's sulcus was dissected to expose the Glissonean branch of S7 and Glissonean branch of S7 was ligated.Then,the demarcation line of S7 was secured and marked.After that,the posterior ligament of the vena cava was dissected to expose the right side of the inferior vena cava(IVC) and the root of the right hepatic vein(RHV). Separated the hepatic parenchyma and transected the branch of the RHV along it's root by the dorsal approach,the route of right hepatic vein was exposed completely.Finally,the anterior approach was adopted along the ischemia demarcation line.This process lasted about 150min and intermittent Pringle maneuver 4 times for 60 min, estimated blood loss was 100ml and no transfusion.The postoperative pathology demonstrated that poorly differentiated hepatocellular carcinoma.
Conclusions Dorsal approach combined with right hepatic vein first procedure for laparoscopic anatomical hepatectomy of S7 is feasible and safety.