Totally laparoscopic central bisectionectomy for hepatocellular carcinoma.

A central bisectionectomy of the liver removes segments 4, 5, and 8, and this is a technically demanding operation because it requires two transection planes. Until now, the laparoscopic approach for this operative procedure has been rarely attempted. We report in this article on a totally laparoscopic central bisectionectomy that was performed in a 49-year-old male who had centrally located hepatocellular carcinoma (HCC), and this tumor was in contact with the middle hepatic vein. The operative procedure was performed by using five trocars with the patient placed in the lithotomy position. The operative time was 430 minutes, the estimated blood loss was about 800 mL, and no perioperative transfusion was needed. The postoperative pathology confirmed a HCC with a 1-cm free resection margin. The patient was discharged on postoperative day 13 without any significant complications. This case shows the feasibility and safety of performing the totally laparoscopic central bisectionectomy for resecting HCC.