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Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience

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Published on: December 4, 2023

Pure Laparoscopic Right Upper Transversal Hepatectomy.

Fei Liu¹, YongGang Wei², Bo Li³

¹Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Annals of Surgical Oncology

|January 23, 2022

Summary

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This study demonstrates the first pure laparoscopic right upper transversal hepatectomy (RUTH) for hepatocellular carcinoma. Laparoscopic RUTH is a safe and feasible option for selected patients, preserving liver function.

Area of Science:

Hepatobiliary Surgery
Minimally Invasive Surgery
Surgical Oncology

Background:

The right upper transversal hepatectomy (RUTH) is a complex parenchymal-sparing liver resection technique.
Previous RUTH procedures were limited to case series and technically challenging.
Laparoscopic RUTH has not been previously reported.

Observation:

A 36-year-old female with HBV-related hepatocellular carcinoma (HCC) presented with a deep S7-8 tumor involving the middle and right hepatic veins.
Preoperative 3-D reconstruction revealed a thick inferior right hepatic vein (IRHV) and communicating veins (CVs).
Standard extended right hepatectomy was not feasible due to insufficient residual liver volume.

Findings:

Pure laparoscopic RUTH was successfully performed using intraoperative ultrasound guidance.

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The procedure involved isolation of hepatic veins, parenchymal transection, and division of tumor-bearing portal pedicles.

The operation lasted 240 minutes with 100 cc blood loss; the patient recovered uneventfully.

Implications:

Laparoscopic RUTH is technically feasible and safe in select patients, particularly those with IRHV and CVs.
This minimally invasive approach offers a potential alternative to open RUTH.
Successful laparoscopic RUTH can preserve liver function while achieving oncological goals.