Laparoscopic Anatomical Resection of the Right Anterior Lobe Based on the Laennec Capsule Technique

Summary

This protocol describes a laparoscopic anatomical right anterior sectionectomy utilizing the Laennec capsule concept, combined with comprehensive preoperative therapy. The approach enables precise tumor resection in hepatocellular carcinoma (HCC) cases closely associated with major vascular structures, improving surgical safety, efficacy, and long-term patient outcomes.

Abstract

This paper presents a laparoscopic anatomical resection technique for hepatocellular carcinoma (HCC) utilizing the Laennec capsule concept. The goal of this protocol is to improve surgical precision and safety during complex liver resections, particularly in tumors closely associated with vital vascular structures, by ensuring clear identification and dissection of critical anatomical landmarks. Surgical resection remains the primary curative treatment for hepatocellular carcinoma (HCC), but laparoscopic anatomical right anterior sectionectomy becomes particularly challenging when tumors are closely associated with major vascular structures, as this increases the risk of significant bleeding. Comprehensive preoperative treatment, including targeted therapy, immunotherapy, and hepatic arterial infusion chemotherapy (HAIC), can reduce tumor size and improve surgical outcomes, making previously borderline resectable tumors operable. In this case, a 75-year-old patient with a tumor in segment 8 (S8) of the liver, closely associated with major vascular structures, underwent two cycles of preoperative treatment. This reduced the tumor size from 6 cm by 5 cm to 4.5 cm by 3.1 cm. Laparoscopic anatomical right anterior sectionectomy was performed using the Laennec capsule, an anatomical structure that aids in vascular dissection. The procedure lasted 240 minutes with minimal blood loss (200 mL). The tumor was successfully resected with negative surgical margins, and the patient was discharged on the seventh postoperative day without complications. Postoperatively, the patient was monitored for signs of liver dysfunction and underwent routine imaging to assess for recurrence. Follow-up included liver function tests and regular CT scans, showing no recurrence after 6 months. This case demonstrates that the combination of the Laennec capsule technique and comprehensive preoperative treatment allows for precise, minimally invasive resections of HCC tumors closely associated with vascular structures, providing a safe and effective solution to challenging liver tumors with minimal intraoperative complications and promising postoperative outcomes.

Introduction

Hepatocellular carcinoma (HCC) is a significant global health concern, representing 75% to 85% of primary liver cancers. It ranks as the 6^th most common malignancy worldwide and is the 4^th leading cause of cancer-related deaths globally¹. In China, HCC remains a major challenge, ranking 4^th in cancer incidence and 3^rd in cancer mortality². The primary goal of managing HCC is to achieve complete resection of the tumor while preserving liver function and minimizing complications, particularly in cases involving tumors adjacent to major vascular structures

Protocol

Prior to the surgery, the patient provided written informed consent. The surgical procedure was approved by the institutional review board at Dongguan Bin-Hai-Wan Central Hospital.

1. Preoperative preparation

1. Neoadjuvant therapy
   1. Targeted therapy: Administer targeted therapy with Lenfacitinib at 8 mg QD, orally for two cycles. Each cycle of comprehensive therapy was administered approximately every 21 days.
      This aims to reduce the tumor size and improve its resectability by inhibiting tumor vascularization and progression.
      ​NOTE: Lenfacitinib is a tyrosine kinase inhibitor that t....

Results

For the protocol described here, the patient, a 75-year-old asymptomatic female, presented with an incidentally detected liver mass. Her medical and surgical history was unremarkable, except for hypertension. Physical examination and vital signs were within normal limits. Further diagnostic evaluations, including imaging and laboratory tests, were conducted to confirm the diagnosis and plan treatment.

On April 23, 2023, further CT and EOB-MR scans confirmed a tumor located in the S8 segment, a.......

Discussion

This paper demonstrates the efficacy of a multimodal treatment approach for a patient with stage IB hepatocellular carcinoma (HCC; AJCC staging: T1bN0M0). The tumor, initially measuring 6.5 cm x 5.5 cm, was closely associated with critical vascular structures, including the second hepatic hilum, inferior vena cava, right hepatic vein, middle hepatic vein, right anterior branch of the portal vein, right posterior branch of the portal vein. Given the tumor's challenging location, a comprehensive treatment strategy was .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Absorbable Suture (Vicryl)	Johnson & Johnson	V-348
Anesthesia Gas (N2O + O2)	Airgas	N2O/O2
General Anesthesia Drugs	Roche	Propofol
Non-absorbable Suture (Prolene)	Ethicon	PROLENE 8698
Povidone Iodine Solution	Betadine	BP-500
Surgical Forceps	Surgical Instruments	SIC-925
Surgical Scissors	Aesculap	KLS Martin 5245
Surgical Sterile Drapes	3M	Surgical Drapes
Titanium Clips	Medtronic	Endo GIA
Ultrasonic Scalpel	Ethicon	Harmonic ACE+