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. 2024 May 24:14:1368678.
doi: 10.3389/fonc.2024.1368678. eCollection 2024.

The safety and feasibility of laparoscopic anatomical left hemihepatectomy along the middle hepatic vein from the head side approach

Wen Li  1 , Lu Fang  1 , Yong Huang  1
Affiliations

The safety and feasibility of laparoscopic anatomical left hemihepatectomy along the middle hepatic vein from the head side approach

Wen Li et al. Front Oncol. .

Abstract

Background: Laparoscopic left hemihepatectomy (LLH) is commonly used for benign and malignant left liver lesions. We compared the benefits and drawbacks of LLH from the head side approach (LLHH) with those of conventional laparoscopic left hemihepatectomy (CLLH). This study was conducted to investigate the safety and feasibility of LLHH by comparing it with CLLH.

Methods: In this study, 94 patients with tumor or hepatolithiasis who underwent LLHH (n = 39) and CLLH (n = 55) between January 2016 and January 2023 were included. The preoperative features, intraoperative details, and postoperative outcomes were compared between the two groups.

Results: For hepatolithiasis, patients who underwent LLHH exhibited shorter operative time (p = 0.035) and less blood loss (p = 0.023) than those who underwent CLLH. However, for tumors, patients undergoing LLHH only showed shorter operative time (p = 0.046) than those undergoing CLLH. Moreover, no statistically significant differences in hospital stay, transfusion, hospital expenses, postoperative white blood cell (WBC) count, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were observed between the two groups (p > 0.05) for tumor or hepatolithiasis. For hepatocellular carcinoma (HCC), no differences in both overall survival (p = 0.532) and disease-free survival (p = 0.274) were observed between the two groups.

Conclusion: LLHH is a safe and feasible surgical procedure for tumors or hepatolithiasis of the left liver.

Keywords: hepatectomy; hepatolithiasis; laparoscopic; left hemihepatectomy; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Surgical techniques for laparoscopic anatomical left hemihepatectomy from the head side approach. (A) Preset hepatic portal block strap. (B) Detachment of the left triangular ligament. (C) The left hepatic vein and the Arantius ligament were exposed. (D) The root of the left hepatic vein and the middle hepatic vein (MHV) were exposed. (E) The left hepatic vein was dissected and detached. (F) The left hepatic vein was severed at the root. (G) Hepatic ischemic line of the left liver. (H) The root of the MHV was exposed. (I) The branch (umbilicus fissure vein) of the MHV was dissected and severed. (J) Parenchymal transection was performed along the MHV toward the tip direction. (K) The left Glissonean pedicle was dissected. (L) Liver section after left hemihepatectomy.
Figure 2
Figure 2
Preoperative 3D reconstruction. (A) Preoperative 3D reconstruction. (B) Positive view of the expected tangent line (black line) of left hemihepatectomy. (C) Upper view of the expected tangent line (black line) of left hemihepatectomy. (D) The left hepatic duct was closely connected to the middle hepatic vein (MHV; black circle). (E) Side view of the left hepatic duct and MHV.
Figure 3
Figure 3
Image of a patient. (A) A preoperative CT image of a patient. (B) Preoperative MRI. (C) Preoperative bile duct water imaging. (D) CT imaging after 1 week.
See this image and copyright information in PMC

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