Laparoscopy-specific ventral approach in laparoscopic hemihepatectomy.

BACKGROUND: The laparoscopic caudal approach is very different from the open ventral approach, specifically with respect to the surgical view, which is completely different and is the underlying reason for why laparoscopic hepatectomy is technically challenging. We have introduced a new laparoscopy-specific ventral approach in laparoscopic hemihepatectomy.

METHODS: The liver was transected from the ventral side to the dorsal side, via a flexible laparoscope, as in open liver resection. The key characteristic of the ventral approach is the early opening of the cranial part, which guides the accurate transection and maintains an open cutting plane. The middle hepatic vein is exposed from the root side toward the periphery.

RESULTS: From March to December 2016, this technique was performed on 12 patients. Of these patients, five underwent right hepatectomy, five underwent left hepatectomy, and two underwent extended left hepatectomy that included the middle hepatic vein. The median operative time was 250 min (range 210-350 min), and the median blood loss was 165 mL (range 100-260 mL). There was no postoperative morbidity or mortality. The median postoperative hospital stay was 8 days (range 5-14 days).

CONCLUSION: This ventral approach may be an effective and feasible technique for laparoscopic hemihepatectomy.