Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach

Laparoscopic liver resection procedures have rapidly developed, including surgical techniques ranging from early local resection of the liver margin and superficial lesions to semi-hepatectomy and even complex liver segment resection. Segment VII of the liver is located at the base of the subphrenic space, making it difficult to access and resulting in a lengthy and challenging resection procedure. This liver segment resection involves high volumes of blood loss throughout the procedure. To reduce bleeding caused by the anatomy of the hepatic porta, our center uses a surgical technique that is guided by the right hepatic vein. This technique is unaffected by anatomical variations, such as the dorsal branch of the hepatic pedicle crossing the right hepatic vein to innervate hepatic segment VII. Here, we provide a method and approach for the anatomical resection of segment VII of the liver with anatomical variations of the portal vein, which can be recommended for clinical practice.