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Updated: May 6, 2026

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Tri-Scenario-Based MAICOHAN Strategy for Minimally Invasive Extended Left Hepatectomy.

Yusuke Yamamoto1, Ryo Morimura1, Taisuke Imamura1

  • 1Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Asian Journal of Endoscopic Surgery
|May 4, 2026
PubMed
Summary
This summary is machine-generated.

The MAICOHAN strategy standardizes minimally invasive extended left hepatectomy (MI-ExLH), reducing operative time and hospital stay. This approach also lowers positive surgical margins in complex MI-ExLH cases.

Keywords:
Arantius‐first approachminimally invasive extended left hepatectomyminimally invasive left hepatectomy

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Area of Science:

  • Hepatobiliary Surgery
  • Minimally Invasive Surgery
  • Surgical Navigation Strategies

Background:

  • Minimally invasive extended left hepatectomy (MI-ExLH) is a complex procedure lacking standardization.
  • Standardization is crucial for improving safety and consistency in MI-ExLH.

Purpose of the Study:

  • To evaluate the efficacy of the tri-scenario-based MAICOHAN strategy for minimally invasive left hepatectomy (MI-LH) and MI-ExLH.
  • To compare outcomes between the MAICOHAN strategy group (MS group) and a non-MAICOHAN strategy group (non-MS group).

Main Methods:

  • Retrospective review of MI-LH and MI-ExLH cases (2018-2025) at a single institution.
  • Classification of surgical strategies based on the MAICOHAN (MHV-based Assessment and Involvement/non-involvement in Caudate-hilum-dependent Optimal extended left Hepatectomy Algorithmic Navigation) strategy.
  • Comparison of operative time, hospital stay, and surgical margin status between the MS and non-MS groups.

Main Results:

  • The MS group (n=11) showed significantly shorter operative times (262 vs. 376 min) and hospital stays (6 vs. 9 days) compared to the non-MS group (n=12).
  • In MI-ExLH cases, the MS group had a significantly lower incidence of positive surgical margins (0% vs. 50%).

Conclusions:

  • The tri-scenario-based MAICOHAN strategy offers a practical framework for planning and performing MI-ExLH.
  • This strategy may enhance the safety and consistency of MI-ExLH procedures.