Laparoscopic anatomical SVIII resection via middle hepatic fissure approach: Caudal or cranio side

Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection, but laparoscopic anatomical SVIII resection (LASVIIIR) remains rarely reported due to poor accessibility, difficult exposure, and the deep-lying Glissonean pedicle. This study examined the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.

To investigate the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.

From November 2017 to December 2022, all patients with a liver tumor who underwent LASVIIIR were enrolled. The perioperative outcomes and postoperative complications were evaluated.

Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included. The mean operation time was 164 ± 54 minutes, and the intra-operative blood loss was 100 mL (range: 20-1000 mL). The mean operative times were, respectively, 152 ± 50 minutes and 222 ± 29 minutes (P = 0.001) for the caudal side and cranial side approaches. In addition, the median blood loss volumes were 100 mL (range: 20-300 mL) and 250 mL (range: 20-1000 mL), respectively, for the caudal and cranial sides (P = 0.064). Three patients treated using the cranial side approach experienced bile leakage, while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover. There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches [9 (7-26) days vs 8 (8-19) days] (P = 0.226).

LASVIIIR resection remains a challenging operation, but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.