Related Experiment Video
Updated: Sep 13, 2025
Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique
Published on: October 6, 2023
Standardized Technique for Minimally Invasive Right Posterior Sectionectomy for Hepatocellular Carcinoma: A
Hisamune Sakai1, Yuichi Goto2, Shogo Fukutomi2
1Department of Surgery, Kurume University School of Medicine, Kurume, Japan; hisamune@med.kurume-u.ac.jp.
Background/Aim:
Minimally invasive right posterior sectionectomy (MIRPS) for hepatocellular carcinoma (HCC) is a technically demanding anatomical liver resection procedure, characterized by restricted visibility and complex hemostatic control. Its effectiveness, compared to that of open surgery, is uncertain. Therefore, this study aimed to compare the perioperative and long-term oncological outcomes of MIRPS and open right posterior sectionectomy (ORPS) for HCC.
Patients And Methods:
Data of 122 consecutive patients, who underwent right posterior sectionectomy as initial treatment for primary HCC from January 2010 to February 2025, were retrospectively analyzed. Patients were allocated to MIRPS and ORPS groups, and surgical outcomes were compared using 1:1 propensity score matching (PSM).
Results:
After PSM, the MIRPS and ORPS groups comprised 35 patients each. No procedures in the MIRPS group required conversion to open surgery. The MIRPS group demonstrated significantly lower blood loss (119 vs. 548 ml; p<0.0001), reduced transfusion rates (0% vs. 11.4%; p=0.0394), shorter operative durations (356 vs. 396 min; p=0.0376), lower postoperative morbidity rates (0% vs. 28.6%; p=0.0006), and shorter postoperative hospital stays (9 vs. 15 days; p<0.0001) compared to the ORPS group. The 1-, 3-, and 5-year overall survival rates were 100%, 96.3%, and 96.3% in the MIRPS group and 100%, 91.2%, and 87.9%, in the ORPS group (p=0.3026), respectively. The 1-, 3-, and 5-year recurrence-free survival rates were 88.5%, 77.1%, and 71.6% in the MIRPS group and 85.7%, 65.4%, and 65.4%, in the ORPS group (p=0.5631), respectively.
Conclusion:
MIRPS reduced perioperative complications, shortened postoperative hospital stay, and achieved recurrence-free and overall survival rates comparable to those of ORPS. Our standardized MIRPS procedure for HCC is considered safe, feasible, and oncologically acceptable for use in selected patients.
Insights
Minimally invasive right posterior sectionectomy (MIRPS) for liver cancer offers significant advantages over open surgery. MIRPS leads to reduced blood loss, fewer complications, and shorter hospital stays while achieving comparable survival rates.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Minimally Invasive Procedures
Background:
- Hepatocellular carcinoma (HCC) treatment often involves anatomical liver resections.
- Minimally invasive right posterior sectionectomy (MIRPS) is a complex procedure with uncertain outcomes compared to open surgery.
- Evaluating MIRPS against open right posterior sectionectomy (ORPS) is crucial for HCC management.
Purpose of the Study:
- To compare perioperative outcomes between MIRPS and ORPS for HCC.
- To assess long-term oncological results of MIRPS versus ORPS in HCC patients.
- To determine the safety and feasibility of MIRPS for selected HCC cases.
Main Methods:
- Retrospective analysis of 122 patients undergoing right posterior sectionectomy for primary HCC.
- Comparison of MIRPS and ORPS groups using 1:1 propensity score matching (PSM).
- Evaluation of surgical outcomes, including blood loss, transfusion rates, operative time, morbidity, and hospital stay.
Main Results:
- MIRPS group (35 patients) showed significantly less blood loss (119 vs. 548 ml) and lower morbidity (0% vs. 28.6%) than ORPS group (35 patients).
- MIRPS resulted in shorter operative times (356 vs. 396 min) and hospital stays (9 vs. 15 days) with no conversions to open surgery.
- Survival rates (overall and recurrence-free) were comparable between MIRPS and ORPS groups at 1, 3, and 5 years.
Conclusions:
- MIRPS for HCC significantly reduces perioperative complications and hospital stay compared to ORPS.
- The oncological outcomes, including survival rates, are comparable between MIRPS and ORPS.
- Standardized MIRPS is a safe, feasible, and oncologically acceptable option for selected HCC patients.
