With benefits such as improved cosmetic results, less postoperative pain, and faster recovery time, singleincision laparoscopic surgery (SILS) has been comprehensively applied in various abdominal surgeries. However, the case of SILS liver resection for malignant hepatocellular carcinoma (HCC) has been rarely reported. Here, we present a case of a SILS hepatectomy in a patient suffering with an 11-cm intrahepatic HCC in the left lateral lobe.A woman 53 years of age was admitted into the hospital

for suspicion of left HCC, and her laboratory tests showed a normal level of a´-fetoprotein and normal liver function (Child-Pugh Score A). Computed tomography (CT) imaging showed a mass of 11-cm with a diameter at the edge of segment IIeIII (Fig. 1A), and no -stasis was detected by positron emission tomography (PET) or CT examination.Considering the lesion located in the edge of liver, SILS

hepatectomy was designed and operated. Before surgery,the patient was informed of all the treatments, risks, and complications, and she signed the consent form for operation using SILS hepatectomy.

Under general anesthesia, a 3.0-cm-long semicircular supraumbilical incision was made (Fig. 1B). Pneumoperitoneum was performed with carbon dioxide at a pressure of 13 mmHg. One 10-mm 30
scope laparoscopy (Olympus, Tokyo, Japan) and two other 5-mm standard laparoscopic instruments were placed into the abdominal cavity. Principles of surgical oncology were strictly adhered

to all throughout the treatment. After exploring the peritoneal cavity with laparoscopy, 10-mm laparoscopic ultrasonography was used to check the liver to reconfirm the location of the tumor, the major intrahepatic vessels to be cut, and the absence of other small tumors. - on perioperative imaging and intraoperative ultrasonography,a transaction line was marked, and the defined liver

parenchyma was carefully dissected with a harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH, USA). The small tracts at the transection plane were cut off by harmonic scalpel and the big vessels were ligated with clips via laparoscopic instruments (Fig. 1C) and endoscopic stapler (Ethicon Endosurgery, Cincinnati, OH, USA). By the end of operation, the dissected mass was encapsulated into

a retrieval bag and extracted out through the trocar site; it was enlarged at about 5 cm, and an abdominal drainagHepatoma,benign tube was placed in hepatectomy lodge. The entire operation

took 125 minutes, with a 95-ml volume of hemorrhage but without any intraoperative blood transfusion. The resection tumor was about 11 cm long (Fig. 1D). Histopathologic analysis showed that the lesion was HCC and there were no carcinoma cells discovered in its margin tissue. The patient was able to walk on the second day after surgery, was withdrawn from the drainage tube on the third

day, and left the hospital on the fourth day.As alternative laparoscopic surgery, SILS has been

reported in the comprehensive literature despite its immaturation.1e4 We began practicing SILS in August 2009 and have conducted 240 cases of cholecystectomy since then with a success rate of 96%. The presented case of partial hepatectomy for a large HCC by SILS indicates that SILS could

be applicable for partial hepatectomy.We also found that the lesion of hepatic segments II to III is the largest hepatocellular carcinoma resected by SILS of all the reports presently.Therefore, SILS hepatectomy may be a promising technique that can be applied to surgical treatment for tumors in the

liver periphery. Further clinical trials should be performed to testify to the safety and feasibility of this application.

——发表在“Journal of the Formosan Medical Association”杂志（SCI收录）上

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