Laparoscopic Anterior-Approach Right Posterior Sectionectomy for Huge Hepatocellular Carcinoma: Technique and
Takeshi Urade1, Masahiro Kido2, Shohei Komatsu2
1Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan. uradet1125@gmail.com.
Background:
Laparoscopic liver resection is technically demanding for hepatocellular carcinoma (HCC) ≥10 cm in the right liver. In open liver resection, the anterior approach is established for large right-lobe tumors because it avoids parenchymal compression during mobilization.1, 2 However, its laparoscopic use remains limited,3 particularly in right posterior sectionectomy (RPS). This study describes the technique and perioperative outcomes of laparoscopic RPS using the anterior approach for huge HCCs.
Methods:
Among 799 minimally invasive liver resections performed between 2011 and 2025, four men (median age 72.5 years, range 60-84) with huge tumors (median diameter 11.5 cm, range 10-12) underwent laparoscopic (extended) RPS with an anterior approach. As the tumor bulk caused firm adhesion to the diaphragm and retroperitoneum, the right lobe was left in situ. Parenchymal transection was initiated caudally and progressed cranially along the right inferior vena cava. The specimen was detached only after the transection. Patients were placed in the left hemilateral decubitus position with French lithotomy, and clamp-crushing was used for transection.
Results:
Two standard and two extended RPSs were completed. The median operative time was 524 minutes (range 418-603), and blood loss was 80 mL (range 10-550); no transfusions were required. The median weight was 753.5 g (range 450-934). No Clavien-Dindo ≥IIIa complications occurred. The median postoperative stay was 11 days (range 9-16). All margins were negative.
Conclusions:
Laparoscopic anterior-approach RPS is feasible and safe for huge right posterior HCCs, enabling secure transection without mobilization and yielding favorable short-term outcomes.
