Laparoscopic hepatectomy for segments I, IV, V and VIII
Related Experiment Video
Updated: Mar 12, 2026
Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
Hongyu Li1, Yonggang Wei2, Bo Li3
1Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
Insights
This study reports the first successful laparoscopic hepatectomy (LH) in China for multiple liver segments (I, IV, V, and VIII). The complex procedure for this difficult liver resection was safely completed with an uneventful recovery.
Area of Science:
- Minimally Invasive Surgery
- Hepatobiliary Surgery
- Surgical Oncology
Background:
- Laparoscopic hepatectomy (LH) for caudate lobe and middle segments is considered highly complex.
- This case represents the first reported LH in China involving liver segments I, IV, V, and VIII.
Observation:
- A 31-year-old male patient presented with a 5.0 cm x 5.2 cm mass in the paracaval portion, diagnosed preoperatively as hepatic adenoma.
- The surgical team utilized intraoperative ultrasonography, the hanging maneuver, Pringle maneuver, and hemi-hepatic vascular inflow occlusion for precise tumor localization and dissection.
- Key vascular structures including the middle hepatic vein and right anterior Glisson's branch were transected, followed by careful dissection along the right hepatic vein root.
Findings:
- The laparoscopic hepatectomy for segments I, IV, V, and VIII was successfully completed in 410 minutes with 300 ml blood loss.
- Postoperative pathological diagnosis confirmed hepatic adenoma.
- The patient experienced an uneventful postoperative recovery.
Implications:
- Laparoscopic hepatectomy for extensive liver segments, including the caudate lobe, is feasible and safe in experienced centers.
- This case expands the application of minimally invasive liver surgery for complex resections.
- Successful execution demonstrates the potential for improved patient outcomes with advanced laparoscopic techniques in challenging hepatobiliary cases.
Background:
According to difficulty scoring system [1], laparoscopic hepatectomy (LH) for caudate lobe and middle segments should be considered as the most difficult case. We here report the first case of LH for segments I, IV, V and VIII in China.
Methods:
The patient was a 31-year-old man without hepatitis history. Preoperative MRI revealed a 5.0 cm × 5.2 cm mass located in the paracaval portion. Preoperative liver function tests and tumor markers were normal. Preoperative diagnose was hepatic adenoma. Informed consents were obtained from the patient himself and his parents. The West China Hospital administration and the ethics committee authorized the surgery.
Results:
After cholecystectomy, the right hemi-liver was mobilized. Intraoperative ultrasonography was used to locate the tumor precisely. A rubber tube was placed through the tunnel between liver and vena cava for the preparation of Hanging maneuver. Parenchymal transection started from segment IV under Pringle maneuver. The superficial of liver was dissected by ultrasonic shears, and the deeper tissue was dissected by ultrasonic aspirator. The hemi-hepatic vascular inflow occlusion was then adopted after dissection of hepatic hilum. The caudate lobe was completely separated from the left lateral lobe and the right posterior lobe. The root of middle hepatic vein and the right anterior Glisson's branch were transected by linear stapler. The cephalic transection was carefully performed along the root of right hepatic vein. Finally, the transection was completed after an exposure of right and left hepatic vein and vena cava, as well as hepatic hilum. The specimen was put into a retrieval bag and removed from suprapubic incision. The operation time was 410 min, and blood loss was 300 ml. Hepatic adenoma was postoperatively diagnosed (Table 1). The postoperative course was uneventful for the patient.
Conclusion:
LH for segments I, IV, V and VIII can be safely performed in selected patient in experienced center.
