Related Experiment Video
Updated: May 8, 2026
Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique
Published on: October 6, 2023
Caudal approach to pure laparoscopic posterior sectionectomy under the laparoscopy-specific view
Hirokazu Tomishige1, Zenichi Morise, Norihiko Kawabe
1Hirokazu Tomishige, Zenichi Morise, Norihiko Kawabe, Hidetoshi Nagata, Hisanori Ohshima, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya Aichi 454-8509, Japan.
This study introduces a novel laparoscopic posterior sectionectomy technique for liver tumors near the right hepatic vein (RHV). The caudal approach facilitates RHV exposure and R0 resection, proving feasible and beneficial for selected patients.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic liver resections near critical structures like the right hepatic vein (RHV) present unique challenges.
- Achieving complete tumor removal (R0 resection) while preserving vital vasculature is paramount.
Purpose of the Study:
- To evaluate a novel caudal approach for laparoscopic posterior sectionectomy.
- To assess the feasibility and efficacy of performing parenchymal transection prior to mobilization under a laparoscopy-specific view.
Main Methods:
- Patients positioned in left lateral decubitus with the posterior sector un-mobilized.
- Extra-hepatic Glissonian pedicle encirclement and division during transection.
- Caudal-initiated dissection of the inferior vena cava (IVC) anterior wall and liver transection to expose the RHV.
Main Results:
- The caudal approach facilitated excellent visualization of the dorsal liver, IVC, and RHV.
- Complete RHV exposure and R0 resection were achieved during liver transection.
- The procedure was successfully performed on a patient with a liver metastasis near the RHV, with an uneventful postoperative course and no recurrence at 14 months.
Conclusions:
- The novel caudal approach laparoscopic posterior sectionectomy is feasible and effective.
- This technique is particularly useful for liver tumors located near the RHV requiring its exposure for complete resection.
