To explore the feasibicity of intrahepatic extra-Glissonian transection approach for laparoscopic left hemihepatectomy.

Laparoscopic left hemihepatectomy was performed for a female with left hepatcellular carcinoma in our department. The tumor size was 5.5 cm. Five trocars was used in the operation. A small incision was made in front of the left hepatic pedicle, blunt dissection following the left hepatic umbilicus template was performed with a golden finger, and then through the front of the caudate lobe Arantius ligament. A silk line was leaded by the golden finger and the left hepatic pedicle was controlled, the ischemia change of the left liver was obvious. Endo-GIA was used to divide the left hepatic pedicle. Liver parenchyma division was performed by combined ultrasound knife and monopolar or bipolar coagulation. Also, the left hepatic vein was divided by Endo-GIA, and no occlusion of the first porta hepatic was performed through out the whole operation.

The surgery was finished in 180 min with 50 ml of blood loss and negative resection margin. The recovery was uneventful without bleeding or bile leakage complication. The patient was discharged at the fourth day after the operation. The pathology was hepatocellular carcinoma with international stage T₁N₀M₀.

The primary clinical practice suggested that in the selected patient, pure laparoscopic left hemihepatectomy was safety and feasible. In this process, intrahepatic extra-Glissonian approach was used to control and divide the left hepatic pedicle, which simplify the operation process, and reducing the blood loss, that was worth to spread utilization.