Comparative analysis of the safety and feasibility of laparoscopic and open approaches for right anterior sectionectomy

Abstract

Laparoscopic hepatectomy has minimally invasive advantages, but reports on laparoscopic right anterior sectionectomy (LRAS) are rare. Herein, we try to explore the benefits and drawbacks of LRAS by comparing it with open right anterior sectionectomy (ORAS). Between January 2015 and September 2023, 39 patients who underwent LRAS (n = 18) or ORAS (n = 21) were enrolled in the study. The patients' characteristics, intraoperative details, and postoperative outcomes were compared between the two groups. No significant differences in the preoperative data were observed between the two groups. The LRAS group had significantly lesser blood loss (P = 0.019), a shorter hospital stay (P = 0.045), and a higher rate of bile leak (P = 0.039) than the ORAS group. There was no significant difference in the operative time (P = 0.156), transfusion rate (P = 0.385), hospital expenses (P = 0.511), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels between the two groups (P > 0.05). Beside, there was no significant difference in disease-free survival (P = 0.351) or overall survival (P = 0.613) in patients with hepatocellular carcinoma between the two groups. LRAS is a safe and feasible surgical procedure. It may be preferred for lesions in the right anterior lobe of the liver.

Keywords: Hepatectomy; Laparoscopic; Liver; Right anterior lobe.

Fig. 1

Surgical steps of LRAS. (A) Gallbladder removal. (B) The hepatic portal vein was blocked with a strap. (C) The Glissonean pedicle of the right anterior lobe was dissected. (D) The hepatic ischemic line of the right anterior lobe. (E) The middle hepatic vein branches of the V and VIII segments were severed. (F) The parenchyma was transected to identify the terminal portion of the RHV. (G) The hepatic vein branches of the RHV were ligated and severed. (H) The Glissonean pedicle of the right anterior lobe was severed. (I) MHV and RHV were exposed on the liver section after LRAS. LRAS, laparoscopic right anterior sectionectomy; RHV, right hepatic vein; MHV, middle hepatic vein.

Fig. 2

Preoperative 3D reconstruction of the left hepatic duct and MHV. (A) Anterior, (B) posterior, (C) superior, (D) inferior, and (E,F) right- and left-side views. 3D, three-dimensional; MHV, middle hepatic vein.

Fig. 3

Radiological images of a representative patient underwent LRAS. (A,B,C) Preoperative MRI. (D) CT obtained 1 week after the surgery.

Fig. 4

The survival curve between the LRAS and ORAS groups. (A) overall survival. (B) the disease-free survival.