Laparoscopic Right Posterior Sectionectomy for Malignant Lesions: An Anatomic Approach

Good indications for laparoscopic hepatectomy are still considered to be tumors located over anterolateral segments of the liver. Tumors located over the right posterior section are considered to be difficult for laparoscopic resection. In this case series, we present our experience on laparoscopic right posterior sectionectomy.

All patient data were prospectively collected. Data on patient demographics, tumor characteristics, operative data, and postoperative outcome were collected and analyzed.

During the period of May 2010-May 2014, we performed 13 laparoscopic right posterior sectionectomies. The diagnoses were hepatocellular carcinoma in 11 patients, of which 2 were cases of colorectal liver metastasis. Median operative time was 381 minutes, and median blood loss was 1500 mL. Significant bleeding occurred in the first 5 patients. The median size of the tumor resected was 3.7 cm, and the median resection margin was 8.7 mm. Four of the 13 patients (30.8%) were cirrhotic on histological examination. There was no postoperative mortality. Median hospital stay was 7 days.

Laparoscopic right posterior sectionectomy is technically demanding. A proper inflow and outflow control is mandatory for proper anatomical resection. This surgical principle should not be compromised in the era of laparoscopic hepatectomy.