Surgical classification of segment VIII: an anatomical model guiding tailored hepatectomy approaches (with video)

While minimally invasive approaches have transformed hepatic surgery, their implementation for VIII segmentectomies continues to present technical challenges.

A retrospective analysis included 18 consecutive patients undergoing laparoscopic S8 or sub-S8 resections. We propose a surgical classification based on G8 anatomical variations and tumor characteristics. Corresponding surgical strategies were developed, incorporating real-time ICG fluorescence navigation and laparoscopic ultrasonography. Cases and the corresponding surgical strategies were classified into three types: Type I (large exophytic tumors limiting mobilization, the Glissonean approach with/without ICG negative staining); Type II (deeper tumors with single/double G8, ICG-positive staining), and Type III (deeper tumors with multiple/high-bifurcating G8 branches, the cranial approach). The tips and tricks of the three operative procedures will be introduced with video assistance in this article.

The cohort comprised Type I (n = 2), Type II (n = 4), and Type III (n = 12) cases. The overall surgical success rate was 94.4% (17/18). Success rates by type were 100% for Type I (2/2), 75% for Type II (3/4), and 100% for Type III (12/12). R0 resection was achieved in all patients (100%). Mean operative time was 179.9 ± 56.42 min, with blood loss of 208.9 ± 103.2 mL (no transfusions required). No conversions to open surgery or major complications (Clavien-Dindo ≥ III) occurred. Postoperative stay averaged 5.84 ± 2.25 days.

This framework emphasizes adaptability to anatomical heterogeneity, balancing oncological radicality with minimally invasive precision. Our initial experience demonstrates that subtype-specific strategies enhance procedural reproducibility and vascular safety in laparoscopic S8 resection, offering a structured approach to overcome this surgical challenge.