Laparoscopic liver resection for large hepatocellular carcinoma located close to ivc

A 51-year-old gentleman from Assam presented with vague abdominal pain. On evaluation, he was found to have a 1O x 9 cm space occupying lesion in right posterior section of liver with imaging features suggestive of Hepato Cellular Carcinoma (HCC). He also had a large left common iliac node suspicious of metastasis. Patient initially underwent diagnostic laparoscopy and lymph node biopsy, which was inflammatory in biopsy. He was then planned for Right Posterior Sectionectomy, which was done successfully by laparoscopic approach. He was discharged on Post Operative Day 3.

What was the cause for HCC in this patient?

HCC usually occurs in liver with cirrhosis or in patients with chronic Hepatitis B virus infection. Rarely, it occurs in patients with normal liver due to causes unidentified. Workup for cirrhosis and viral infection were negative in this patient.

What is the advantage of laparoscopy in this patient?

Smaller incision and avoiding upper abdominal incision for specimen retrieval helps in smooth post operative recovery without pulmonary complications. Our patient was discharged on post operative day 3 uneventfully.

How complex is it to do laparoscopically?

Although we remove only two segments of liver, right posterior section has significant volume around one third of liver volume. Moreover, the transection surface is horizontal as it is posteriorly placed making it technically demanding. In our patient, tumor was also large-10 cm and was very close to right hepatic vein making dissection tougher. Better vision and intra abdominal pressure during laparoscopy reduces blood loss from veins and helps precisely identifying vessels. Amongst laparoscopic liver resection, posterior sectionectomy is considered one of the most complex procedures.