By reviewing the diagnosis and treatment process of a pediatric patient with primary fibrolamellar hepatocellular carcinoma (FLC) who underwent laparoscopic surgery at our center, we summarize and discuss the technical experience of combining Laennec approach with dorsal approach in minimally invasive management of FLC.

Based on a 12-year-old pediatric patient with a hepatic space-occupying lesion admitted to the Department of Hepatobiliary Surgery at Wuxi Xishan People′s Hospital in Mar. 2025, who was clinically diagnosed with FLC, a laparoscopic surgical strategy was formulated after thorough preoperative evaluation.

The patient successfully underwent laparoscopic left hemihepatectomy via the Laennec approach (intracapsular dissection) combined with a dorsal approach, along with hilar lymph node dissection and cholecystectomy. The procedure was associated with minimal intraoperative blood loss. Postoperatively, there were no complications such as infection, hemorrhage, bile leakage, or portal vein thrombosis. The patient recovered smoothly. Pathological examination confirmed the diagnosis of FLC.

Surgery remains the only effective strategy for treating FLC. For tumors adjacent to the sagittal portion of the hepatic hilum, a laparoscopic hepatectomy utilizing the Laennec approach (intracapsular dissection) combined with a dorsal approach could be adopted after systematic and comprehensive preoperative evaluation. This strategy ensures adequate surgical margins, reduces intraoperative bleeding, enhances procedural safety, and ultimately benefits the patient.