Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach

Laparoscopic hepatectomy has gained widespread acceptance as a minimally invasive alternative to open liver resection, offering reduced postoperative pain, shorter hospital stays, and faster recovery. Among its various techniques, laparoscopic right hemihepatectomy via the in situ anterior approach represents a significant advancement in oncological and surgical safety. Unlike conventional methods requiring full mobilization of perihepatic ligaments, this approach preserves the liver's anatomical position throughout resection. By avoiding excessive rotation or compression of the liver parenchyma, it mitigates the risks of iatrogenic tumor dissemination, capsular rupture, and hemorrhage, critical concerns in malignancy surgery. This technique is especially advantageous for high-risk scenarios: (1) exophytic tumors with fragile capsules susceptible to rupture during manipulation, (2) large tumors (>10 cm) where mobilization may compromise vascular control, and (3) cases with venous tumor thrombus where dislodgement could lead to catastrophic embolism. The in situ strategy aligns with the principles of tumor-free surgery (no-touch technique) and precision hepatectomy, as it enables direct visualization of deep vasculobiliary structures without destabilizing the liver. Early clinical studies report lower transfusion rates and reduced conversion to open surgery compared to traditional approaches. Given its technical feasibility and oncological rigor, the in situ anterior approach should be prioritized for complex liver resections, particularly in centers with advanced laparoscopic expertise. Further multicenter studies are warranted to standardize its procedural steps and validate long-term oncologic outcomes. Nonetheless, current evidence supports its adoption as a first-line minimally invasive strategy for large or high-risk liver space-occupying lesions.