Laparoscopic Anatomical S7 Segmentectomy: A Standardized Combined Dorsal and Ventral Method

Anatomical resection of tumor in liver segment S7 is the most technically challenging procedure in laparoscopic liver hepatectomy due to its deep location and complex vascular structures, which results in a steep learning curve for beginners. We explored a simple and feasible approach: a dorsal approach combined with a dorsoventral method for liver segment S7 resection.

The key innovations we propose through the dorsal approach combined with a dorsoventral method include the following: (1) systematic dissection of the S7 hepatic pedicle through Rouviere's sulcus; (2) parenchymal transection guided by the dorsal ischemic demarcation line of segment S7; (3) advance along the right hepatic vein toward the ventral aspect of segment S7. By decomposing complex maneuvers into three standardized steps (steps 1-3), this protocol significantly reduces technical barriers. The procedural details are meticulously demonstrated in this report to enhance reproducibility.

In the preliminary phase of this study, 20 patients were included. All patients underwent surgery smoothly, with no conversion to open surgery and no deaths, and all patients achieved R0 resection. The operation time was 190.0 (178.0-210.0) min, and intraoperative blood loss was 200.0 (150.0-280.0) mL.

This method standardizes the laparoscopic S7 segment resection, which, while ensuring precise removal, is expected to reduce the learning curve for surgeons.