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Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach
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Total Intravenous Anaesthesia and an Opioid-Sparing Strategy for an Extended Left Hemihepatectomy with Total Caudate

Sing Ying Pang1, Jan Ngian1, Selene Tan1

  • 1Department of Anaesthesiology, Singapore General Hospital, Singapore, SGP.

Cureus
|October 15, 2025
PubMed

We present a case of a 72-year-old man who underwent an open extended left hemihepatectomy and total caudate lobe resection with total hepatic vascular exclusion (THVE) for a large hepatocellular carcinoma (HCC). Anaesthetic management included the use of intrathecal opioids and total intravenous anaesthesia (TIVA) with propofol and remifentanil. Due to tumour adherence to the right hepatic vein-inferior vena cava junction, venovenous (VV) bypass and cold in situ perfusion were required. This case illustrates neurocognitive protection principles, electroencephalogram (EEG)-guided depth of anaesthesia monitoring, multimodal opioid-sparing analgesic strategies, enhanced recovery principles, and sustainable, low-emission TIVA anaesthetic maintenance, exemplifying an integrative approach in high-complexity liver surgery.

Keywords:
major hepatectomymultimodal analgesiasustainable anaesthesiatotal hepatic vascular exclusiontotal intravenous anaesthesia

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