Laparoscopic Anatomical Resection of Liver Segment 8 via a Hepatic Parenchymal Transection-first Approach Guided by the Middle Hepatic Vein

Background: Although recent technological developments and improved endoscopic procedures have further extended the application of laparoscopic liver resection, pure laparoscopic anatomic resection of liver segment 8 (S8) is still rarely performed due to the lack of an appropriate surgical approach. This article discusses the technical tips and operation methods for laparoscopic anatomical resection of liver S8 via a hepatic parenchymal transection-first approach. Methods: Clinical data of 14 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein (MHV) in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from May 2017 to December 2019 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, and hospitalization duration were observed. Results: The operation was successful with no complications. No other abnormality was noted during outpatient follow-up examination. Conclusions: Laparoscopic anatomical resection of liver S8 is still quite challenging at present, and it is our goal to design a reasonable procedure with accurate efficacy and high safety. We use hepatic parenchymal transection-first approach guided by the MHV for laparoscopic anatomical resection of liver S8. This technique overcomes the problem of high technical risk, greatly reduces the surgical difficulty and achieves technological breakthroughs, but there are still many problems worth further exploration.