Laparoscopic left-sided hepatectomy guided by dilated bile ducts as anatomical landmarks for hepatolithiasis: a...

Hepatolithiasis, prevalent in East and Southeast Asia, often leads to complications such as cholangitis, strictures, and cholangiocarcinoma. Conventional interventions frequently leave residual stones, requiring repeat treatments. We evaluated a modified laparoscopic left-sided hepatectomy guided by dilated bile ducts (DBDs) as anatomical landmarks [modified laparoscopic left-sided hepatectoMy guided by dilated bile ducTs as aNatomical lAnmarks (MITNA) approach]-with reference to the middle hepatic vein (MHV) when necessary-to optimize stone clearance and preserve healthy liver.

In this prospective study, 32 consecutive patients undergoing laparoscopic left-sided hepatectomy for hepatolithiasis at 108 Military Central Hospital (January 2023-January 2025) were enrolled. Preoperative imaging identified the extent of DBDs. Patients with disease confined to the left lateral lobe underwent left lateral hepatectomy (LLH) with the transection line placed to the right of the falciform ligament. Those with disease extending to segment 4 or near the hilum underwent left hemihepatectomy (LHH), using a transection plane between DBDs and the MHV. Perioperative data (operative time, blood loss, complications, stone clearance) and follow-up outcomes were collected.

All 32 patients completed laparoscopic hepatectomy without conversion, 22 underwent LLH and 10 had LHH. The mean operative time was 140.7±46.8 min with the mean blood loss 111.5±70.8 mL. Postoperative complications occurred in 12.5% of patients (Clavien-Dindo grade I-IIIa). The mean hospital stay was 7.7±2.5 days. At a mean follow-up of 9.50±4.08 months, only one patient (3.1%) had residual stones, which were successfully cleared through endoscopic intervention, resulting in a final stone clearance rate of 100%.

The MITNA approach is a feasible and promising approach for left-sided hepatolithiasis. This approach ensures complete resection of affected bile ducts and stones while sparing normal liver parenchyma, resulting in high stone clearance rates and low morbidity.