Laparoscopic Liver Resection for the Tumors Compressing Inferior Vena Cava and the Root of Hepatic Vein Using a Step-By-Step Approach.

[INTRODUCTION] Laparoscopic liver resection (LLR) offers advantages such as reduced blood loss and enhanced visualization. However, cases involving tumors compressing the inferior vena cava (IVC) or the root of the hepatic veins remain technically challenging.

[MATERIALS AND SURGICAL TECHNIQUE] We present two cases of LLR for tumors compressing IVC and the root of hepatic veins. We developed a new surgical strategy termed the "step-by-step approach", which alternates between liver mobilization and parenchymal transection to safely detach the liver from major vessels. The procedure prevents critical bleeding from major vessels by maintaining liver mobility and ensuring sufficient working space. Case 1 was a 68-year-old man with a 6.5 cm hepatocellular carcinoma (HCC) in Spiegel's lobe compressing IVC and left hepatic vein. Laparoscopic partial hepatectomy of segment 1 was performed. Case 2 was an 82-year-old man with a 5.2 cm HCC in segment 7 compressing IVC and right hepatic vein (RHV). Laparoscopic posterior sectionectomy and dorsal resection of anterior section with combined resection of RHV were performed.

[DISCUSSION] Both cases were successfully resected without critical bleeding, achieving a negative surgical margin. This procedure may expand surgical indications to more advanced cases, offering both feasibility and safety.