Laparoscopic anatomic mesohepatectomy for patients with hepatocellular carcinoma (HCC) remains technically challenging, especially for those with a massive tumor larger than 10 cm. In this study, a 65-year-old man with a 13 × 10-cm2 solitary liver tumor located at segments 4, 5, and 8 underwent laparoscopic mesohepatectomy. To reduce the possibility of releasing cancer cells from the primary tumor, the in situ resection strategy for tumor removal was implemented. Indocyanine green (ICG) then was applied using “reverse staining” to visualize the resection extent and the right posterior hepatic duct (RPHD). During parenchymal resection, the right anterior Glissonean pedicle was adequately exposed and transected via the extrafascial approach above the plane of the RPHD. Finally, the right coronary ligament was dissected, and the tumor was removed. The operation was completed in 360 min, with a blood loss of 200 mL. The patient was discharged on postoperative day 8 without any complications. Laparoscopic in situ anatomic mesohepatectomy with ICG navigation may be feasible for patients with a centrally located solitary massive HCC.
https://link.springer.com/article/10.1245/s10434-021-10886-2
