Background : Laparoscopic anatomical liver resection of segment II can be a challenging surgical procedure, with few reports existing in literature. 3D rendering and ICG-fluorescence represent a useful tool for correct preparation and execution of the procedure.

Methods : A 65 years old male patient with history of metabolic cirrhosis and diabetes came to our attention from the institutional MDT because of a radiological finding of a 3.5 cm sized nodule of the segment II. Pre-operative CT-scan showed a nodule presenting the typical features of HCC, with close relationships with the left hepatic vein. A pre-operative 3D-rendering was built to deeply investigate the relationships between the lesion and the surrounding vascular structures, as well as to plan the anatomical liver resection.

Results : Liver was mobilized by dividing the falciform ligament and the left triangular ligaments. Laparoscopic US was performed to confirm the lesion and its relationship to vascular and biliary structures. The dissection of G2 was performed at the umbilical plate, following the insertion of the round ligament. G2 was charged on a vessel loop and closed with a bulldog. ICG was intravenously administered to obtain a negative counterstaining that guided the transection line. Liver transection was started using an energy device and then completed by using the CUSA. The portal pedicles and the Vein draining segment 2 were secured by hem-o-locks.

Conclusions : A laparoscopic anatomical liver resection of segment 2 can be safely and successfully performed, in selected cases. Recent technological advances can help the minimally invasive surgeon and be useful to reach improved outcomes.