Laparoscopic Cranial Approach for Anatomical Resection of Liver Segment VIII: A Technical Case Report

Laparoscopic anatomical hepatectomy is an established therapeutic standard for liver malignancies; however, the resection of Segment VIII (S8) remains technically demanding due to its deep cranial location and proximity to the middle hepatic vein (MHV) and right hepatic vein (RHV). This protocol outlines a structured, step-by-step cranial approach to facilitate safe and precise laparoscopic anatomical segmentectomy of S8. The objective is to demonstrate a reproducible surgical strategy that overcomes the exposure difficulties inherent to this segment. The protocol is exemplified through a 65-year-old male patient with a history of hepatitis, Child-Pugh A liver function, and a 4 cm S8 hepatocellular carcinoma (HCC) abutting the MHV and RHV. After confirming adequate future liver remnant (FLR/SLV ratio: 70.5%), the procedure was performed using a systematic cranial-to-caudal workflow. Dissection of the second hepatic hilum is first performed to identify and expose the roots of the MHV and RHV. Using these venous landmarks as anatomical guides, the parenchymal transection plane is then clearly demarcated and developed from the hepatic vein roots downwards. Key steps include the use of intraoperative ultrasound for confirmation, piecemeal in-situ transection, and intermittent Pringle maneuver application under low central venous pressure anesthesia. In this case, the protocol was successfully executed, achieving en bloc resection of S8 with an operative time of 160 min and an estimated blood loss of 100 mL. The patient experienced no postoperative complications and was discharged on day seven. Histopathology confirmed HCC. This report outlines a standardized laparoscopic cranial approach that may assist surgeons in performing anatomically guided resections of deep cranial liver segments.