Laparoscopic PVL and terminal branch portal vein embolization followed by laparoscopic hepatectomy for HCC: With a video vignette

Insufficient future liver remnant (FLR) is one of the most important factors causing the low resection rate of hepatocellular carcinoma(HCC),and surgeons have explored many methods to increase the FLR volume before surgery such as portal vein embolization (PVE), portal vein ligation (PVL) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). However, these methods still have some drawbacks such as long waiting time, insufficient liver hyperplasia, and high postoperative complication and mortality rate. In response to this, we have developed a new surgical method of laparoscopic portal vein ligation and terminal branches portal vein embolization to improve the future liver remnant. This method was performed in a 49-year-old male hepatocellular carcinoma patient. This study introduced this surgical procedure and includes a video vignette for a comprehensive understanding. This patient underwent the first stage of laparoscopic portal vein ligation and terminal branches portal vein embolization successfully, the operation time was 157 min. No surgery-related complications occurred, and the postoperative hospital stay was 5 days. 28 days after the 1st stage operation, the FLR increased 203.7 cm 3 (69.4 %). Then, the patients underwent the 2nd step of laparoscopic right hemihepatectomy. The patient recovered well and was discharged 8 days after the surgery. This two-step hepatectomy strategy is a safe and effective strategy to increase the resectability of HCC patients with insufficient liver volume. It has the advantage of simplifying the surgical procedure and increasing the liver volume obviously.