2017 Volume 53 Issue 5 Pages 1073-1078
Reports on laparoscopic hepatectomy for malignant tumors in children are few. We present a case of pure laparoscopic partial hepatectomy for hepatoblastoma. A baby girl with Beckwith-Wiedemann syndrome underwent surgical closure of an omphalocele on the sixth day of life. At 4 months, sonographic screening revealed a liver tumor. The alpha-fetoprotein level was 23,060.69 ng/ml, and contrast-enhanced computed tomography revealed a 3.7-cm mass at the left lateral segment of the liver. A biopsy of the mass confirmed the diagnosis of hepatoblastoma (PRETEXT I). After 4 cycles of cisplatin monotherapy, the size of the tumor decreased to 2.7 cm. Laparoscopic partial hepatectomy was performed when she was 6 months old. An umbilical incision was made in an inverted Y shape, allowing for E-Z AccessTM with a Lap ProtectorTM insertion through which a 1.2-cm trocar was introduced. Two 5-mm working ports were placed lateral to the rectus muscle of either side immediately superior to the umbilicus. After placing a tape around the porta hepatis for the Pringle maneuver in the case of severe bleeding, intraoperative ultrasonography was performed for the identification of the vascular tree and hepatic and portal veins, and the localization of the tumor for accurate and safe resection. Enseal® was used to divide the hepatic parenchyma. Branched vessels and ducts were clipped and transected using Enseal®. The surgical specimen was extracted through the umbilical incision without enlarging the incision. The patient had an uncomplicated recovery. No recurrence was observed during a 2-year follow-up.
