Six-patient series describes tailored laparoscopic liver resection approach

Laparoscopic extended right posterior sectionectomy, including the dorsal part of the right anterior section, can preserve more liver tissue than right hepatectomy but requires identification of a variable anatomical boundary. In this consecutive series, six patients underwent the procedure between December 2020 and July 2023. Preoperative three-dimensional reconstruction assessed right anterior Glissonean pedicle anatomy and whether a definite anterior fissure vein (AFV) was present. Surgeons used an AFV-guided transfissural approach when the vein was identified, or an intrahepatic Glissonean approach when it was absent. Indocyanine green fluorescence was used to confirm the ischemic boundary after pedicle ligation.

A definite AFV was identified in five patients (83.3%). Median tumor size was 31 mm (range 15–52 mm), and all six resections had negative margins. Median operative time was 260 minutes, median blood loss was 175 mL, and no patient required transfusion. Median hospital stay was 6.5 days (range 5–21); one patient developed postoperative ileus, and there were no perioperative deaths.

The report offers a technical framework for a complex, parenchyma-preserving liver operation. Its findings are preliminary: the series includes only six patients and provides no comparative assessment of outcomes. The authors emphasize careful case selection.