Laparoscopic Anatomic S4 Segmentectomy for Hepatocellular Carcinoma

Introduction: When hepatocellular carcinoma (HCC) is located in the S4 segment, resection of only the S4 segment is more beneficial than performing a left hemihepatectomy as resection of only the S4 segment preserves the liver volume of the left lateral segment. We report here a case of performing a total laparoscopic S4 segmentectomy with resection of the middle hepatic vein, which was in contact with the HCC. Methods: A 63-year-old man was admitted for an incidentally detected hepatic mass. The preoperative liver function was Child-Pugh class A. An abdominal computed tomographic scan revealed a 3.2 cm HCC that was located in the superior portion of segment 4 and the HCC was in contact with the middle hepatic vein. A laparoscopic extended S4 segmentectomy was performed. Results: The operative time was 440 minutes. The estimated intraoperative blood loss was approximately 800 mL; no intraoperative transfusion was necessary. The patient was discharged on the 10th postoperative day without any postoperative complications. Conclusions: This case shows the feasibility of performing a laparoscopic S4 segmentectomy in selected patients.