Background : The laparoscopic hepatectomy of the mass adjacent to the diaphragm has been challenging tasks to surgeons. In usual diamond-core port system, access to the liver dome was demanding and often can lead to open conversion or postoperative morbidities. In this presentation, we report a case of laparoscopic right hemihepatectomy in hepatocellular carcinoma (HCC) patients with additional 12mm port lateral to preexisting surgeon’s left-hand port.

Methods : The patients was a 69-years old male without any high risk of hepatocellular carcinoma. Preoperative imaging showed a 7cm-diameter mass in right posterior section of liver. Unlike our routine laparoscopic hepatectomy, which was diamond-core port system, additional port as lateral as right anterior axillary line (AAL port) was inserted. After partial mobilization, parenchymal dissection was done except the part of adhesion between the mass and the diaphragm. The inflow and outflow was divided using endoscopic staplers. A Bulldog clamp was applied to the partial diaphragm through the AAL port and then linear stapler was used to divide the mass abutting site. The opening of the diaphragm was closed. The absence of the pneumothorax was confirmed by the air-leak test. After that, the operation was ended as usual.

Results : About 7cm sized HCC with diaphragm invasion was reported at final pathological diagnosis. Fortunately, resection margin of the diaphragm side had no tumor extension. Postoperative course of the patient was uneventful.

Conclusions : Inserting additional port at the lateral side of routine surgeon’s left-hand port, partial division of diaphragm wall and primary repair was facilitated without open conversion of the surgery.