Related Experiment Video
Updated: Feb 12, 2026
Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
Tips and Tricks for a Laparoscopic Approach to Paracaval Liver Segments
G Fiorentini1, F Ratti2, F Cipriani2
1Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy. fiorentini.guido@hsr.it.
Background:
A dramatic spread of laparoscopic liver surgery has been experienced over the last years. The approach to paracaval liver segments 1 and 9 is still poorly described in literature, mainly due to its technical demands.
Objective:
The aim of this article was to introduce a safe and effective approach to paracaval liver segments through laparoscopy.
Methods:
A minimally invasive approach to resection of Segments 1 and 9 is presented, and an operative set-up is depicted. A step-by-step technique describing the inferior vena cava (IVC) with left and right hepatic venous junction exposure, segmental pedicle isolation, and parenchymal transection is shown through a video document.
Results:
Postoperative courses were uneventful, and patients were discharged on postoperative day 3.
Discussion:
The approach to paracaval liver segments requires accurate preoperative case selection, technical, surgical, and anesthesiological expertise in laparoscopic liver surgery, and adequate instrumentary.
Conclusion:
Paracaval segments of the liver can be approached safely through laparoscopy by teams with extensive expertise in the field of laparoscopic liver surgery; however, suspected malignant infiltration of the IVC or unclear preoperative anatomy still contraindicate this approach.
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