Effectiveness of pure laparoscopic right hepatectomy with a combined anterior and cranio-ventral approach for a giant hemangioma in a young woman.

Pure laparoscopic right hepatectomy is a challenging procedure especially for large tumors because of difficulties in mobilizing the liver and the risk of bleeding. An anterior approach has been proposed to overcome these problems. In this case report, we described a young unmarried woman with a giant hemangioma who successfully underwent pure laparoscopic right hepatectomy using the anterior approach. After transection of the anterior and posterior Glissonean pedicles, the liver parenchyma was divided using the cranio-ventral approach. The middle hepatic vein was exposed from the root side to periphery without split injury, and branches were safely divided. Because the tumor completely compressed the right hepatic vein (RHV), the inferior RHV (IRHV) was well-developed instead. After transecting both RHV and IRHV, the right lobe was mobilized and removed through a Pfannenstiel incision in the lower abdomen. The surgery was completed without tumor injury, and the blood loss was low. The postoperative course was uneventful and the patient was very satisfied with the wound appearance. This case suggests that the combination of the anterior and cranio-ventral approach may reduce bleeding from the tumor and bleeding due to injury of the hepatic vein in the case of giant tumors, contributing to safe hepatectomy.