title: Laparoscopic anatomic S4 segmentectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  When hepatocellular carcinoma (HCC) is located in the S4 segment, resection of only the S4 segment is more beneficial than performing a left hemihepatectomy as resection of only the S4 segment preserves the liver volume of the left lateral segment. We report here a case of performing a total laparoscopic S4 segmentectomy with resection of the middle hepatic vein, which was in contact with the HCC.
  
  
  METHODS
  A 63-year-old man was admitted for an incidentally detected hepatic mass. The preoperative liver function was Child-Pugh class A. An abdominal computed tomographic scan revealed a 3.2 cm HCC that was located in the superior portion of segment 4 and the HCC was in contact with the middle hepatic vein. A laparoscopic extended S4 segmentectomy was performed.
  
  
  RESULTS
  The operative time was 440 minutes. The estimated intraoperative blood loss was approximately 800 mL; no intraoperative transfusion was necessary. The patient was discharged on the 10th postoperative day without any postoperative complications.
  
  
  CONCLUSIONS
  This case shows the feasibility of performing a laparoscopic S4 segmentectomy in selected patients.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Keun Soo
authors.initials: KS
authors.lastname: Ahn
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.forename: Yoo-Seok
authors.initials: YS
authors.lastname: Yoon
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed