Surgical Endoscopy

, Volume 31, Issue 8, pp 3349–3350 | Cite as

Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure

  • Varvara A. Kirchner
  • Ki-Hun KimEmail author
  • Seok-Hwan Kim
  • Sang-Kyung Lee



Laparoscopic hepatectomy is a common procedure that has been reported frequently [1, 2, 3]. However, laparoscopic resection of tumors located in hepatic segments 5 and/or 8 remains a technically difficult procedure as it requires two transection planes [4]. Furthermore, there are a greater number of hepatic vein and glissonian pedicle branches that require a division as compared to other hepatectomy operations. In this report, we present a pure laparoscopic right anterior sectionectomy (RAS) for hepatocellular carcinoma (HCC).


Preoperative imaging showed HCC (3 cm × 4 cm) in segment 5 [5]. After selective anterior segment inflow occlusion, transection lines were demarcated. Complete Pringle maneuver was performed for 15 min intervals five times during hepatic parenchymal transection. The Cavitron Ultrasonic Surgical Aspirator was used for the transection of the hepatic tissue. Small hepatic vein branches along the middle and right hepatic veins and small glissonian pedicles were clipped, sealed and divided with EnSEAL (TM) (Ethicon). iDrive (TM) Ultra Powered Stapling device (Medtronic) was used for the division of tertiary glissonian pedicles. Hanging maneuver was performed for transection of remaining liver parenchyma after complete division of hepatic venous branches. The specimen was removed through the lower abdominal transverse incision using the endocatch bag. Jackson-Pratt drain was left in the operative field. All work was performed with IRB approval.


Pure laparoscopic RAS for HCC was performed successfully without intraoperative complications or transfusions. The operation time was 300 min, and the estimated blood loss was <200 ml. On postoperative day 5, computed tomography scan showed well-perfused hepatic parenchyma. Pathology specimen confirmed 3.2 cm × 3 cm × 2.2 cm HCC without involvement of surgical resection margins. The patient was discharged on postoperative day 7 without complications.


Pure laparoscopic RAS is a feasible operative procedure in patients with tumors located in hepatic segments 5/8.


Laparoscopic hepatectomy Right anterior sectionectomy Hepatocellular carcinoma 


Compliance with ethical standards


Drs. Varvara A. Kirchner, Ki-Hun Kim, Seok-Hwan Kim and Mr. Sang-Kyung Lee have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 180009 kb)


  1. 1.
    Kim KH et al (2006) Clinical analysis of right anterior segmentectomy for hepatic malignancy. Hepatogastroenterology 53(72):836–839PubMedGoogle Scholar
  2. 2.
    Yoon SY et al (2015) Oncological and surgical results of laparoscopic versus open liver resection for HCC less than 5 cm: case-matched analysis. Surg Endosc Other Interv Tech 29(9):2628–2634CrossRefGoogle Scholar
  3. 3.
    Dagher I et al (2014) International experience for laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 21(10):732–736CrossRefPubMedGoogle Scholar
  4. 4.
    Hwang DW et al (2012) Totally anatomic laparoscopic right anterior sectionectomy. J Laparoendosc Adv Surg Tech A 22(9):913–916CrossRefPubMedGoogle Scholar
  5. 5.
    Cho A et al (2011) Safe and feasible extrahepatic Glissonean access in laparoscopic anatomical liver resection. Surg Endosc 25(4):1333–1336CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Varvara A. Kirchner
    • 1
  • Ki-Hun Kim
    • 2
    Email author
  • Seok-Hwan Kim
    • 2
  • Sang-Kyung Lee
    • 2
  1. 1.Division of Transplantation, Department of SurgeryUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of Hepato-biliary and Liver Transplantation, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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