A Technique for Laparoscopic Right Hepatectomy Following Portal Vein Embolization in a Patient With Portal Vein Thrombosis: A Case Report

Laparoscopic right hepatectomy following portal vein embolization remains challenging because of its technical complexity. One possible problem during hepatectomy including portal vein (PV) embolization is PV thrombosis. A 79-year-old man with a massive hepatocellular carcinoma underwent laparoscopic right hepatectomy following PV embolization. Three weeks after embolization, estimated future liver remnant volume had increased sufficiently to permit right hepatectomy, but a thrombus of moderate size was detected in the right portal vein. Thrombectomy during laparoscopic resection is difficult, involving risk of uncontrollable bleeding. To decrease risk, the right portal pedicles were cut using a stapler at the roots of segments 5 and 8 and the right posterior portal pedicles while monitoring with ultrasonography, rather than cutting the main right portal pedicle. The postoperative course was uneventful except for a period of hyperbilirubinemia controlled by conservative measures. The patient is alive without recurrence at 6 months after surgery. Our procedure may increase safety of right hepatectomy following PV embolization.