A case of laparoscopic hepatic S4 partial resection after coronary artery bypass grafting using the right gastroepiploic artery

Laparoscopic liver resection has become safer over time, making it a viable option for patients previously considered high-risk. We discuss a case in which a 73-year-old man underwent laparoscopic liver resection after coronary artery bypass grafting using the right gastroepiploic artery (RGEA). The patient was noted to have liver metastases of rectal cancer in the medial segment. Laparoscopic hepatic S4 partial resection was done after preoperative assessment of the RGEA graft pathway by computed tomography. During the operation, the RGEA graft was adherent to the dorsal surface of the liver, but the laparoscopic approach allowed fine dissection. The tumor was then safely removed, and the patient was discharged without complications. Preoperative assessment of the graft pathway is necessary because of the lack of tactile sensation during laparoscopic surgery. However, a magnified view of the laparoscope enabled us to perform fine dissection to avoid injury to the graft vessels.