Laparoscopic Partial Liver Resection for Hepatocellular Carcinoma in Liver Cirrhosis

Background/Aims: Liver resection by open surgery remains the treatment of choice for hepatocellular carcinoma (HCC). However, open surgery with a large skin incision carries the possibility of liver failure in patients with advanced liver cirrhosis, because large skin incisions lead to interruption of large collateral veins. Currently, laparoscopic liver resection is preferred to avoid postoperative liver failure in these circumstances. Methodology: We describe laparoscopic treatment of three patients with a single sub glissonian HCC, using small skin incisions. The tumor lesions were located in segment 3, segment 6 and segment 8, according to Couinaud's liver anatomy on each patient. In the patient with the S8 lesion, we approached the region from the pleural cavity using a THORACO-PORT (TM). The diaphragm was incised with a Harmonic scalpel (TM) and the tumor was removed from the pleural cavity through a 5-cm long skin incision. In the patient with S3 and that with S6 lesion, we performed mobilization of the lateral segment or the right lobe by laparoscopy. We then used a mini-retractor and Nelaton tube to bring the tumor to the subcostal region and easily performed a partial resection, which was all that could be done under the circumstances. Results: All the patients were able to start oral intake on the three postoperative days, and didn't require analgesic agent. The mean post operative stay was 8.7 days. Conclusion: in cases of hepatocellular carcinoma that require partial liver resection, a laparoscopic procedure is a reasonable approach to surgery, because of its lower invasiveness compared with conventional liver resection.