A laparoscopic approach is being used increasingly in specialist centres for the resection of hepatocellular carcinomas and compares favourably with the traditional open approach, in terms of perioperative morbidity and mortality as well as long-term survival. We present a case of port site recurrence in a patient who underwent a laparoscopic left lateral segmentectomy for a hepatocellular carcinoma diagnosed during investigation of symptomatic gallstones. Nearly three years following surgery, surveillance computed tomography demonstrated a suspicious lesion at the site of one of the laparoscopic ports. Further resection was carried out and the lesion was confirmed histologically to be an isolated recurrence of the primary hepatocellular carcinoma, involving peritoneum and adominal wall. This case demonstrates that it is possible to encounter port site metastasis following laparoscopic resection of primary liver tumours although the incidence is very rare. Over the last decade, laparoscopic liver resection has become broadly accepted as an alternative to open surgery in appropriately selected patients. The 2008 Louisville consensus statement on laparoscopic liver surgery concluded that small hepatocellular carcinomas (HCCs), either in the context of a normal background liver or compensated cirrhosis, could be safely resected laparoscopically provided that this was undertaken in experienced centres. 2 The authors found that laparoscopic liver resection was associated with less intraoperative blood loss and a reduced incidence of postoperative liver failure but had no impact on either margin positivity rates or tumour recurrence. To our knowledge, there are no published reports of isolated port site recurrence following laparoscopic liver resection for hepatocellular cancer. In this paper, we report one such case occurring nearly three years following liver resection. Case HistoryWe present the case of a 68-year-old woman who, while being investigated for symptomatic gallstone disease, was found on ultrasonography to have a mass lesion in the left lateral aspect of the liver. Subsequent triple phase computed tomography (CT) and liver protocol magnetic resonance imaging confirmed the lesion to have characteristic features of HCC.The patient's past medical history included hyperthyroidism, type 2 diabetes mellitus, hypertension and cerebrovascular disease. She had also received a recent diagnosis of a ductal carcinoma of the left breast and a decision was therefore made to proceed with a laparoscopic cholecystectomy with biopsy of the liver lesion in the first instance. This confirmed the presence of a well differentiated HCC and so she underwent a laparoscopic left lateral liver resection a few weeks later, without complication. The specimen was retrieved in an Endo Catch bag (Covidien, Dublin, Ireland). Histology confirmed the presence of a 45mm Edmondson grade 2 HCC over 3cm from the closest surgical resection margin. The breast cancer was treated subsequently with wide local excision and external beam r...