A Stepwise Approach to Laparoscopic Mesohepatectomy: From Complexity to Standardization with Video Demonstration.

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Oncologic Procedures
• Surgical Standardization

Background:

• Mesohepatectomy is indicated for centrally located liver tumors when parenchymal-sparing approaches are not feasible.
• The procedure involves complex anatomical considerations, including managing major hepatic veins and sectorial inflows.
• Minimally invasive techniques like laparoscopic and robotic surgery are increasingly used for mesohepatectomy.

Purpose of the Study:

• To describe a standardized laparoscopic technique for mesohepatectomy.
• To provide a stepwise approach for safely performing this complex liver surgery.
• To highlight the role of indocyanine green (ICG) guidance in anatomical landmark identification.

Main Methods:

• A five-trocar laparoscopic technique without liver mobilization was employed.
• The procedure followed five sequential steps: Glissonean pedicle approach, inflow occlusion, hepatic vein dissection, and ICG-guided parenchymal transection.
• Indocyanine green (ICG) was used to stain the remnant liver and guide parenchymal transection.

Main Results:

• The technique was demonstrated in a 75-year-old patient with hepatocellular carcinoma.
• The patient experienced an uneventful postoperative recovery.
• The patient was discharged on postoperative day 4.

Conclusions:

• Laparoscopic mesohepatectomy can be safely performed in selected patients.
• Standardization of the surgical steps is crucial for enhancing safety and reproducibility.
• This technique offers a reproducible method for complex liver resections.