ADVANCED SURGICAL TECHNOLOGY IN OPEN LEFT HEPATECTOMY FOR HEPATOCELLULAR CARCINOMA: A CASE REPOR alexrossano@yahoo.com

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ADVANCED SURGICAL TECHNOLOGY IN OPEN LEFT HEPATECTOMY FOR HEPATOCELLULAR CARCINOMA: A CASE REPOR

5

Mexico

Oral or Poster

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and often requires surgical resection for curative intent. Achieving safe and precise hepatectomy remains challenging, particularly in elderly patients. Recent advances in intraoperative technology have enhanced the surgeon’s ability to optimize outcomes. We present a case where a multimodal intraoperative strategy was implemented during an open left hepatectomy in a 73-year-old female with HCC.

Pre-resection planning was refined using intraoperative ultrasound to delineate tumor margins and vascular structures. Indocyanine green (ICG) fluorescence imaging facilitated segmental demarcation and bile duct identification. Parenchymal transection was performed with an ultrasonic surgical aspirator (CUSA) and bipolar radiofrequency sealing (Aquamantys). Vascular inflow and outflow control were achieved using endoscopic linear staplers. Intraoperative cholangiography was used to confirm biliary anatomy and ensure ductal preservation.

Parenchymal dissection was performed meticulously with multiple hemostatic technologies. Estimated blood loss was 300 mL, with no transfusion required. Negative resection margins (R0) were achieved. There were no intraoperative or early postoperative complications. The patient was discharged in stable clinical condition. At three-month follow-up, she remains asymptomatic, with normal liver function tests and no signs of residual or recurrent disease on imaging.

This case illustrates the advantages of integrating real-time imaging, advanced energy devices, and vascular staplers during liver resection. The coordinated use of ICG, CUSA, and Aquamantys can optimize safety and outcomes, particularly in complex hepatectomies in elderly patients.