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Updated: Mar 14, 2026
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Laparoscopic Right Hepatectomy: Toward Protocolization and Simplification
Sung Hoon Choi1, Gi Hong Choi2,3, Dai Hoon Han4
1Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Insights
This study introduces a simplified protocol for laparoscopic right hepatectomy (LapRH), addressing key surgical challenges. The streamlined technique enables safe and successful minimally invasive liver resection procedures.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Procedures
- Surgical Technique Optimization
Background:
- Laparoscopic right hepatectomy (LapRH) presents significant challenges, including complex liver mobilization, difficulties with the hanging maneuver, and reliance on experienced surgical assistants.
- Existing protocols for LapRH often lack standardization, potentially hindering widespread adoption and consistent outcomes.
- The need for simplified, reproducible techniques in LapRH is critical for improving patient safety and surgical efficiency.
Observation:
- A novel six-step protocol for LapRH was developed, focusing on curtailed mobilization, direct vascular control, and alternative retraction methods.
- The simplified technique replaces the traditional hanging maneuver with a lifting-up approach using standard laparoscopic graspers or retractors.
- The procedure was systematically broken down to enhance clarity and facilitate easier execution by surgical teams.
Findings:
- In a series of 13 LapRH procedures, the simplified protocol demonstrated feasibility with a low conversion rate to open surgery (1/13).
- Mean operative time was 381 minutes with an average blood loss of 633 ml, indicating manageable surgical parameters.
- No significant postoperative complications were observed, and the mean hospital stay was 9.1 days, suggesting favorable patient recovery.
Implications:
- Protocolization and simplification of LapRH can enhance understanding and execution of the procedure, potentially improving port placement and overall surgical performance.
- This simplified approach may broaden the accessibility of safe and effective minimally invasive liver resections.
- Further adoption of this protocol could lead to standardized training and improved outcomes in laparoscopic liver surgery.
Background:
Major hurdles for laparoscopic right hepatectomy (LapRH) include difficulties in (1) mobilization and (2) applying hanging maneuver and (3) lack of experienced assistants. We discuss the protocolization of lapRH, introducing our simplified technique.
Methods:
The procedure was disassembled into six steps: (1) curtailed mobilization of the right liver so as to align the resection plane with the laparoscopic camera view, (2) inflow vascular control, (3) setting up the parenchymal resection applying the rubber band retraction method, (4) parenchymal resection approaching the caudate lobe, (5) a lifting-up maneuver using a laparoscopic grasper or retractor instead of the hanging maneuver, and (6) completion of resection dividing the caudate lobe, right hepatic vein, and remaining ligament.
Results:
Between March 2014 and August 2015, 13 LapRH surgeries were attempted. The patients consisted of eight males and five females with a mean age of 58.5 ± 11.6 years. Final pathological diagnoses were hepatocellular carcinoma in seven patients, intrahepatic duct stone in 4, and colorectal liver metastasis in 2. The mean total operative time was 381 ± 66 minutes, and the mean intraoperative estimated blood loss was 633 ± 619 ml. One patient was converted to open surgery. There was no clinically significant complication, and the mean length of stay after surgery was 9.1 ± 2.3 days.
Conclusions:
Protocolization and simplification of the procedure may allow professionals to better understand the respective process and determine appropriate port placements, resulting in safe and successful minimally invasive hepatectomy procedures.
