Left jackknife position: a novel position for laparoscopic hepatectomy.

Area of Science:

• Hepatobiliary surgery
• Minimally invasive surgery
• Surgical oncology

Background:

• Laparoscopic hepatectomy for hepatocellular carcinoma (HCC) in liver segments VI, VII, or VIII presents challenges due to poor operative exposure.
• The unique anatomical structure of these posterior segments complicates standard surgical approaches.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic hepatectomy using the left jackknife position for HCC in segments VI, VII, or VIII.
• To assess the feasibility of achieving adequate surgical exposure in these challenging liver locations.

Main Methods:

• A prospective study involving 10 patients undergoing laparoscopic hepatectomy for HCC in segments VI, VII, or VIII.
• Utilized the left jackknife position to optimize operative exposure.
• Preoperative imaging (CT/MRI) guided tumor localization.
• Recorded key surgical outcomes including operation time, blood loss, and postoperative recovery metrics.

Main Results:

• All 10 laparoscopic hepatectomies were completed successfully without conversion to open surgery.
• No major postoperative complications were reported.
• Median tumor size was 31 mm; mean operation time was 166 minutes; mean blood loss was 220 mL.
• Median postoperative hospital stay was 4 days.

Conclusions:

• Laparoscopic hepatectomy using the left jackknife position is a safe and effective approach for HCC in liver segments VI, VII, and VIII.
• This technique provides sufficient operating field exposure for successful tumor resection.
• The left jackknife position represents a novel advancement for minimally invasive liver surgery in challenging locations.