Pushing the Boundaries of Minimally Invasive Surgery: Fully Laparoscopic Left Hepatectomy Extended to Segment 8 for Bilobar Colorectal Liver Metastases

The surgical management of hepatic metastases from colorectal cancer may range from segmental resections to major or extended hepatectomies. The aim is to achieve complete removal of metastatic lesions while preserving adequate liver function. We present the case of a 42-year-old male patient with a history of glucose intolerance who presented with altered bowel movements and abdominal pain. After further evaluation, he was diagnosed with stage IV rectosigmoid cancer with potentially resectable bilobar liver metastases in segments 2, 4a-8, and 6. KRAS, NRAS, and BRAF were wild-type, and no microsatellite instability was detected. The patient underwent six cycles of chemotherapy with FOLFOX (oxaliplatin in combination with 5-fluorouracil and leucovorin), and radiofrequency ablation (RFA) was applied to the lesion in segment VI, resulting in a favorable response in imaging control. Consequently, we perform a laparoscopic extended left hepatectomy with wedge resection of the segment VI lesions previously treated with RFA. The video shows a completely laparoscopic left hepatectomy extended to segments 5 and 8 and also a resection of S6 metastasis. It is possible to appreciate the management of the left hepatic pedicle and the transection of the parenchyma with the use of energy instruments: cavitron ultrasonic surgical aspirator and bipolar. In addition to the dissection and section of the middle and left hepatic vein included in the surgical specimen. The patient experienced a rapid postoperative recovery with good liver function, an early hospital discharge, and a quick return to work, highlighting the clear advantages of laparoscopic surgery.