To evaluate the feasibility and safety of laparoscopic right anterior lobectomy with prior Glisson extrathecal occlusion in patients with hepatocellular carcinoma (HCC).

Clinical data of 4 HCC patients who underwent laparoscopic right anterior lobectomy with Glisson extrathecal occlusion in the First People's Hospital of Foshan from November 2016 to August 2018 were retrospectively analyzed. All patients were male, aged from 40 to 72 years with a median age of 65 years. The tumors were located in segments Ⅴ and Ⅷ. The maximum diameter was 3.3-4.2 cm, and the median diameter was 3.5 cm. The informed consents of all patients were obtained and the local ethical committee approval was received. Glisson extrathecal occlusion of the right anterior lobe was performed priorly in the operation. The margin of the right anterior lobe was accurately marked according to the ischemic zone. The liver parenchyma was dissected following the middle and right hepatic veins.

All the patients underwent total laparoscopic hepatectomy successfully. No case was converted to open surgery. No perioperative death was reported. The mean operation time, intraoperative blood loss and length of postoperative hospital stay were (502±55) min, (512±301) ml and (10.7±2.9) d, respectively. One patient suffered from bleeding at 3 d after operation and healed after open surgery. One case suffered from liver sectional effusion at postoperative 7 d and treated with catheter drainage. One patient developed pleural effusion on the right side at 2 weeks after operation and received thoracentesis. The postoperative follow-up time was 12-36 months, and the median follow-up time was 24 months. One case recurred during the follow-up.

Laparoscopic right anterior lobectomy with prior Glisson extrathecal occlusion for HCC is safe and feasible, which conforms to the concept of precise hepatectomy.