Laparoscopic resection of segments 7 and dorsal 8: glissonean pedicle-first and IRHV-first approaches

Laparoscopic resection of hepatic segments 7 and dorsal 8 (Sg7 + Sg8d) is technically demanding due to the deep anatomical location and proximity to the right hepatic vein (RHV), inferior vena cava (IVC), and diaphragm. At present, no standardized approach has been established. We herein provide the first summary of two distinct approaches-inferior right hepatic vein(IRHV)-first and Glissonean pedicle-first-for laparoscopic Sg7 + Sg8d resection. Patients who underwent laparoscopic Sg7 + Sg8d resection at our institution were retrospectively reviewed. Surgical strategies were planned according to the presence or absence of the IRHV. Two representative cases were selected: one performed with an IRHV-first approach and the other with a Glissonean pedicle-first approach. In the Glissonean pedicle-first case, a 50-year-old male with hepatocellular carcinoma located between Sg7 and Sg8d without IRHV underwent Sg7 + Sg8d resection via a Glissonean pedicle-first approach. Operative time was 340 min, blood loss was 200 ml, and recovery was uneventful. In the IRHV-first case, a 49-year-old female with an epithelioid angiomyolipoma in Sg7 and a prominent IRHV underwent successful Sg7 + Sg8d resection with preservation of IRHV drainage. Operative time was 355 min, blood loss was 300 ml, and recovery was uneventful. Laparoscopic resection of Sg7 + Sg8d resection can be safely and effectively performed using the IRHV-first approach when IRHV is present, or the Glissonean pedicle-first approach when IRHV is absent.