Background : Segment 8 (s8) can be subdivided into two areas: ventral (s8v) and dorsal (s8d), and anatomical subsegmentectomy of s8 is a challenging procedure due to the anatomical variations. In recent years, several approaches have been described to perform laparoscopic resection of s8 or one of its subsegments. We present cases of laparoscopic anatomical resection of the s8v and s8d performed using transfissural and transparenchymal glissonean approaches.

Methods : We performed 2 cases of laparoscopic s8 dorsal subsegmentectomy and 1 case of laparoscopic s8 ventral subsegmentectomy in patients with hepatocellular carcinoma (HCC) requiring parenchymal sparing liver resection. The patient who had previously undergone liver resection was operated on in the left lateral position, while the other patients were operated on in the supine position. The position of the ventral and dorsal branch bifurcation of the right anterosuperior portal vein was confirmed intraoperative ultrasound, and the glissonean pedicle and hepatic vein were identified with transfissural approach for s8v resection and transparenchymal approach for s8d resection. The glissonean pedicle was then clamped and liver was resected along the ischemic demarcation line.

Results : The mean operative time was 270 mins and the mean estimated blood loss was 503 ml. Final pathologic results were HCC, and all had surgical margins greater than 10mm. With the exception of one patient who had a percutaneous drainage for fluid collection in resection area, the other patients were discharged without events.

Conclusions : Laparoscopic anatomical resection of the s8v and s8d performed using transfissural and transparenchymal glissonean approach is an effective and safe procedure.