Introduction : Anatomical parenchymal resection is theoretically effective treatment of hepatocellular carcinoma. We describe the laparoscopic approach of anatomical right inferior bisegmentectomy using the Glissonian approach.

Methods : Between March 2014 and December 2017, 8 patients who diagnosed hepatocellular carcinoma underwent this operation. The presenting patient was diagnosed with 1.3 cm and 1.1 cm sized two hepatocellular carcinomas on segment 5 and 6. There was mild liver cirrhosis without sign of clinical portal hypertension. The patient was placed in the reverse Trendelenburg position with right-side-up adjustment. Four ports (two 12-mm and two 5-mm ports) were used. After cholecystectomy, the right major, right posterior, and right anterior Glissonian pedicles were isolated and looped in order. The first resection plane between segment 5 and 4 was determined on ischemic discoloration clamping the right major Glissonian pedicle. Approaching to hilar level during the first parenchymal resection, the Glissonian pedicles of segment 5 and 6 were respectively identified and clamped. Then, the ischemic demarcation of segment 5 and 6 could be confirmed. Intermittent Pringle's maneuver was used.

Results : There was no open conversion. The mean operation time and mean estimated blood loss were 206.3 minutes (range, 150 to 350 min) and 331.3 mL (range, 80 to 800 mL). The mean postoperative hospital stay was 7.5 days (range, 5 to 10 days). All patients obtained negative resection margins. There was no postoperative mortality, but there was one morbidity of cerebral transient ischemic attack.

Conclusions : Laparoscopic anatomical right inferior bisegmentectomy is a feasible operative procedure.