Laparoscopic Left Lateral Sectionectomy: Guided by the Ligamentum Teres Hepatis and the Umbilical Fissure Vein

Laparoscopic left lateral sectionectomy guided by the ligamentum teres hepatis and umbilical fissure vein effectively controls intraoperative bleeding even without controlled low central venous pressure and prevents loss of direction during parenchymal dissection.

My research focuses on minimally invasive surgical treatments for hepatobiliary and pancreatic tumors. Guided by ligamentum teres hepatis and the umbilical fissure vein, this laparoscopic left lateral sectionectomy procedure effectively controlled intraoperative bleeding, even in the absence of controlled low central venous pressure. These attributes offer the potential benefit for patients with cardiovascular or cerebrovascular conditions.

Advanced imaging modalities, such as indocyanine green fluorescence imaging, can provide real-time visualization of liver anatomy, aiding in surgical planning and decision making. The advantage of our technique is that it avoids hepatic hilar dissection. Second, during liver parenchymal dissection, we utilize the intrahepatic anatomic landmark of the umbilical fissure vein as a guide to prevent loss of direction.

To begin the left liver lobe mobilization, use an ultrasonic scalpel to dissect the hepatic round ligament and falciform ligament of the anesthetized patient. Then, completely divide the triangular ligament and coronary ligament to reveal the root of the left hepatic vein. Next, employ a grasper posterior to the hepatic pedicle via the foramen of Winslow to facilitate the placement of a cotton tape.

Extract the ends of the cotton tape through a five millimeter port trocar under the guidance of the grasper. After removing the five millimeter trocar, thread one end of the cotton tape through a suction tube and advance it into the abdominal cavity up to the hepatic pedicle. Maintain the external end of the cotton tape outside the patient's body.

Next, using an ultrasonic scalpel, dissect the superficial peritoneum along the left side of the ligamentum teres hepatis. Dissect the Glissonean pedicles for segments two and three from the ventral to the dorsal side, and excise them using clips or a stapler. Then, dissect the hepatic parenchyma along the umbilical fissure vein within the hepatic parenchyma to identify the root of the left hepatic vein.

Divide the small vessels with the ultrasonic scalpel. After dividing the large vessels, transect the left hepatic vein with a stapler. Finally, utilize bipolar electrocoagulation forceps to coagulate the hemorrhagic points.

The CT scan on postoperative day five showed no blood or fluid accumulation in the liver section. Histological examination revealed intrahepatic bile duct stones, inflammatory cell infiltration, and small bile duct proliferation in the porta hepatis region. The postoperative incision healed satisfactorily without infection.