Laparoscopic Extended Anterior Hepatic Sectionectomy with Right Hepatic Venous Tumor Thrombectomy (with Video)

Abstract

Although laparoscopic hepatectomy (LH) has become more widely performed, LH with tumor thrombectomy is a technically challenging procedure. There are a few reported cases of LH with tumor thrombectomy involving the portal vein or bile duct, however there are no reports of LH with hepatic venous tumor thrombectomy. A 66-years-old man presented with a 6-cm hepatocellular carcinoma in liver segment VIII and an hepatic venous tumor thrombus in the right hepatic vein (RHV). Because the future liver remnant for right hemihepatectomy was estimated to be insufficient, we performed extended anterior sectionectomy with hepatic venous tumor thrombectomy, preserving V7. After cholecystectomy, the anterior Glissonean pedicle was isolated and clamped and the demarcation line was identified under indocyanine green fluorescence imaging. After mobilization of the right liver and division of the short hepatic veins, the RHV was controlled. Liver parenchymal resection was performed along the demarcation line. The middle hepatic vein was exposed and V5 and V8 were subsequently divided. The anterior Glissonean pedicle was divided using an endostapling device. After clamping the root of the RHV, the anterior surface of the distal RHV was incised for tumor thrombectomy. The stump of the RHV was closed using an endostapling device, preserving V7. Further hepatic parenchymal resection was performed and the planned hepatectomy was completed. Computed tomography on postoperative day 7 showed complete removal of the tumor and tumor thrombus, with preservation of V7. The patient was discharged on postoperative day 10 with no complications.