Laparoscopic left ventral hepatic segmentectomy (with video)

Abstract Background The anatomical resection of Segment 3 and 4 of the liver under conventional laparotomy was reported [ 1 ]. We present the laparoscopic approach for this type of resection. Method Laparoscopic left ventral hepatic segmentectomy [ 2 ] including the Segment 3 (S3) and the ventral Segment 4 (S4v), preserving the Segment 2 (S2) and the dorsal Segment 4 (S4d), was performed for the hepatocellular carcinoma located at the root of the Glissonean pedicle of the S3. Video After the pneumoperitoneum and the mobilization of the left lateral segment, the Glissonean pedicle for the left ventral segment was controlled and occluded. The demarcation line between the left ventral segment and the Segment 2 (S2), the dorsal Segment 4 (S4d) and the Segment 5 (S5) was confirmed using indocyanine green-fluorescence imaging [ 3 ]. The hepatic parenchymal resection was started along the demarcation line between the S3 and S2 on the dorsal lateral segment [ 4 ], followed by the division of the Glissonean pedicle of the left ventral segment. Further parenchymal division between the S4v and S4d, and that between the S4v and S5 resulted in the completion of the laparoscopic left ventral hepatic segmentectomy. Results The operative time was 221 minutes and the intraoperative blood loss was 10 ml. The postoperative course was uneventful and the patient was discharged 7days after the surgery. Conclusions The left ventral hepatic segmentectomy could be among the standard choices of laparoscopic anatomical resection for a tumor located around the top of the umbilical portion in selected HBP institutes.