Name: Laparoscopic Anatomical Resection of the Right Anterior Lobe Based on the Laennec Capsule Technique (Video) | JoVE Journal
Uploaded: 2025-05-02T13:10:00.000+00:00
Duration: 6 min 11 s
Description: Learn laparoscopic anatomical resection of the right anterior lobe using the Laennec capsule technique for hepatocellular carcinoma. This protocol combines intraoperative ultrasound and ICG imaging to improve surgical precision and patient outcomes.

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5 minutes

This study was supported by the Guangdong Medical Science and Technology Research Fund (Grant No. B2022197).

<ol><li>Bray, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Global+cancer+statistics+2018%3A+GLOBOCAN+estimates+of+incidence+and+mortality+worldwide+for+36+cancers+in+185+countries%5BTitle%5D)+AND+%22CA+Cancer+J+Clin%22%5BJournal%5D)">Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.</a> CA Cancer J Clin. 68 (6), 394-424 (2018).</li>
<li>Chen, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Cancer+statistics+in+China%2C+2015%5BTitle%5D)+AND+%22CA+Cancer+J+Clinicians%22%5BJournal%5D)">Cancer statistics in China, 2015.</a> CA Cancer J Clinicians. 66 (2), 115-132 (2016).</li>
<li>Llovet, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Hepatocellular+carcinoma%5BTitle%5D)+AND+%22Nat+Rev+Disease+Primers%22%5BJournal%5D)">Hepatocellular carcinoma.</a> Nat Rev Disease Primers. 7 (1), 6(2021).</li>
<li>Finn, R. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Atezolizumab+plus+bevacizumab+in+unresectable+hepatocellular+carcinoma%5BTitle%5D)+AND+%22New+Engl+J+Med%22%5BJournal%5D)">Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma.</a> New Engl J Med. 382 (20), 1894-1905 (2020).</li>
<li>El-Khoueiry, A. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Nivolumab+in+patients+with+advanced+hepatocellular+carcinoma+%28CheckMate+040%29%3A+An+open-label%2C+non-comparative%2C+phase+1%2F2+dose+escalation+and+expansion%5BTitle%5D)+AND+%22Lancet%22%5BJournal%5D)">Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): An open-label, non-comparative, phase 1/2 dose escalation and expansion.</a> Lancet. 389 (10088), 2492-2502 (2017).</li>
<li>Aoki, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Anatomical+liver+resection%3A+A+novel+concept+and+detailed+technical+aspects%5BTitle%5D)+AND+%22Ann+Surg%22%5BJournal%5D)">Anatomical liver resection: A novel concept and detailed technical aspects.</a> Ann Surg. 271 (2), e13-e16 (2020).</li>
<li>Kiguchi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Use+of+the+inter-Laennec+approach+for+laparoscopic+anatomical+right+posterior+sectionectomy+in+semi-prone+position%5BTitle%5D)+AND+%22Surg+Oncol%22%5BJournal%5D)">Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position.</a> Surg Oncol. 29, 140-141 (2019).</li>
<li>Amin, M. B., et al. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aAmin%2C+MB+%22AJCC+Cancer+Staging+Manual%22">AJCC Cancer Staging Manual</a>. , Springer International Publishing. (2017).</li>
<li>Kudo, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Lenvatinib+versus+sorafenib+in+first-line+treatment+of+patients+with+unresectable+hepatocellular+carcinoma%3A+A+randomized+phase+3+non-inferiority+trial%5BTitle%5D)+AND+%22Lancet%22%5BJournal%5D)">Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: A randomized phase 3 non-inferiority trial.</a> Lancet. 391 (10126), 1163-1173 (2018).</li>
<li>Lu, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+clinical+development+of+tislelizumab+in+the+treatment+of+cancers%3A+A+comprehensive+review%5BTitle%5D)+AND+%22Biol+Targets+Ther%22%5BJournal%5D)">The clinical development of tislelizumab in the treatment of cancers: A comprehensive review.</a> Biol Targets Ther. 14, 39-48 (2020).</li>
<li>Lammer, J., Malagari, K., Vogl, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Local+therapies+for+liver+tumors%3A+Status+and+perspectives%5BTitle%5D)+AND+%22J+Hepatol%22%5BJournal%5D)">Local therapies for liver tumors: Status and perspectives.</a> J Hepatol. 62 (5), 1377-1389 (2015).</li>
<li>He, M. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((toripalimab%2C+plus+hepatic+arterial+infusion+chemotherapy+versus+lenvatinib+alone+for+advanced+hepatocellular+carcinoma%5BTitle%5D)+AND+%22Ther+Adv+Med+Oncol%22%5BJournal%5D)">toripalimab, plus hepatic arterial infusion chemotherapy versus lenvatinib alone for advanced hepatocellular carcinoma.</a> Ther Adv Med Oncol. 13, 17588359211002720(2021).</li>
<li>Jiao, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+activity+and+safety+of+penpulimab+%28Anti-PD-1%29+with+anlotinib+as+first-line+therapy+for+advanced+hepatocellular+carcinoma+%28HCC%29%5BTitle%5D)+AND+%22J+Clin+Oncol%22%5BJournal%5D)">Clinical activity and safety of penpulimab (Anti-PD-1) with anlotinib as first-line therapy for advanced hepatocellular carcinoma (HCC).</a> J Clin Oncol. 38 (suppl 15), 4592-4592 (2020).</li>
<li>Sugioka, A., Kato, Y., Tanahashi, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Systematic+extrahepatic+Glissonean+pedicle+isolation+for+anatomical+liver+resection+based+on+Laennec%27s+capsule%3A+Proposal+of+a+novel+comprehensive+surgical+anatomy+of+the+liver%5BTitle%5D)+AND+%22J+Hepato-Biliary-Pancreatic+Sci%22%5BJournal%5D)">Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec's capsule: Proposal of a novel comprehensive surgical anatomy of the liver.</a> J Hepato-Biliary-Pancreatic Sci. 24 (1), 17-23 (2017).</li>
<li>Hayashi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Connective+tissue+configuration+in+the+human+liver+hilar+region+with+special+reference+to+the+liver+capsule+and+vascular+sheath%5BTitle%5D)+AND+%22J+Hepato-Biliary-Pancreatic+Surg%22%5BJournal%5D)">Connective tissue configuration in the human liver hilar region with special reference to the liver capsule and vascular sheath.</a> J Hepato-Biliary-Pancreatic Surg. 15 (6), 640-647 (2008).</li>
<li>Kiguchi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+S7+segmentectomy+using+the+inter-Laennec+approach+for+hepatocellular+carcinoma+near+the+right+hepatic+vein%5BTitle%5D)+AND+%22Surg+Oncol%22%5BJournal%5D)">Laparoscopic S7 segmentectomy using the inter-Laennec approach for hepatocellular carcinoma near the right hepatic vein.</a> Surg Oncol. 31, 132-134 (2019).</li>
<li>Hu, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laennec%27s+approach+for+laparoscopic+anatomic+hepatectomy+based+on+Laennec%27s+capsule%5BTitle%5D)+AND+%22BMC+Gastroenterol%22%5BJournal%5D)">Laennec's approach for laparoscopic anatomic hepatectomy based on Laennec's capsule.</a> BMC Gastroenterol. 19 (1), 194(2019).</li>
<li>Yarchoan, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Feasibility+and+efficacy+of+neoadjuvant+cabozantinib+and+nivolumab+in+patients+with+borderline+resectable+or+locally+advanced+hepatocellular+carcinoma+%28HCC%29%5BTitle%5D)+AND+%22J+Clin+Oncol%22%5BJournal%5D)">Feasibility and efficacy of neoadjuvant cabozantinib and nivolumab in patients with borderline resectable or locally advanced hepatocellular carcinoma (HCC).</a> J Clin Oncol. 39 (suppl 3), 335(2021).</li>
<li>Zhang, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+real-world+study+of+PD-1+inhibitors+combined+with+TKIs+for+HCC+with+major+vascular+invasion+as+the+conversion+therapy%3A+A+prospective%2C+non-randomized%2C+open-label+cohort+study%5BTitle%5D)+AND+%22Ann+Oncol%22%5BJournal%5D)">A real-world study of PD-1 inhibitors combined with TKIs for HCC with major vascular invasion as the conversion therapy: A prospective, non-randomized, open-label cohort study.</a> Ann Oncol. 31 (suppl 6), 1307(2020).</li>
<li>He, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Sorafenib+plus+hepatic+arterial+infusion+of+oxaliplatin%2C+fluorouracil%2C+and+leucovorin+vs+sorafenib+alone+for+hepatocellular+carcinoma+with+portal+vein+invasion%3A+A+randomized+clinical+trial%5BTitle%5D)+AND+%22JAMA+Oncol%22%5BJournal%5D)">Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: A randomized clinical trial.</a> JAMA Oncol. 5 (7), 953-960 (2019).</li>
<li>Zhang, X., Tan, Z., Li, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Challenges+in+laparoscopic+liver+resection%3A+Review+of+techniques+and+limitations+in+patients+with+complex+tumors%5BTitle%5D)+AND+%22Hepatol+Intl%22%5BJournal%5D)">Challenges in laparoscopic liver resection: Review of techniques and limitations in patients with complex tumors.</a> Hepatol Intl. 14 (2), 225-233 (2020).</li>
</ol>

The authors have nothing to disclose.

This paper demonstrates the efficacy of a multimodal treatment approach for a patient with stage IB hepatocellular carcinoma (HCC; AJCC staging: T1bN0M0). The tumor, initially measuring 6.5 cm x 5.5 cm, was closely associated with critical vascular structures, including the second hepatic hilum, inferior vena cava, right hepatic vein, middle hepatic vein, right anterior branch of the portal vein, right posterior branch of the portal vein. Given the tumor&#39;s challenging location, a comprehensive treatment strategy was ...

Hepatocellular carcinoma (HCC) is a significant global health concern, representing 75% to 85% of primary liver cancers. It ranks as the 6th most common malignancy worldwide and is the 4th leading cause of cancer-related deaths globally1. In China, HCC remains a major challenge, ranking 4th in cancer incidence and 3rd in cancer mortality2. The primary goal of managing HCC is to achieve complete resection of the tumor while preserving liver function and minimizing complications, particularly in cases involving tumors adjacent to major vascular structures
Managing HCC becomes particularly complex when tumors are located near vital hepatic structures. The close proximity to these critical structures significantly complicates surgical intervention, necessitating a strategic approach to treatment. The challenges are exacerbated by risks of intraoperative bleeding, incomplete resection, and postoperative complications, highlighting the need for innovative surgical techniques and comprehensive preoperative management
Recent advancements in multidisciplinary treatment strategies, including targeted therapy, immunotherapy, and hepatic arterial infusion chemotherapy (HAIC), have shown promise in managing such challenging cases3. These therapies aim to reduce tumor size and improve surgical outcomes, making previously inoperable tumors amenable to resection4,5. In this context, the concept of the Laennec capsule, which focuses on precise anatomical dissection within the hepatic capsule, provides a framework for performing complex liver surgeries with improved precision and safety6,7.
This paper presents a patient with stage IB HCC, where neoadjuvant therapy comprising targeted therapy, immunotherapy, and HAIC successfully reduced the tumor size. Following this multimodal treatment, a laparoscopic anatomical right anterior sectionectomy was performed using the Laennec capsule concept. This approach enabled meticulous dissection of the right anterior branch of the portal vein, middle hepatic vein, and right hepatic vein, facilitating a successful resection with clear margins. The overall goal of this method is to integrate advanced neoadjuvant therapies with minimally invasive surgical techniques to achieve safe and effective resections of complex HCC cases, particularly those involving tumors closely associated with critical vascular structures.
The integration of advanced therapeutic modalities and innovative surgical techniques underscores progress in managing complex HCC cases, offering patients enhanced surgical outcomes and improved prognoses. Compared to conventional approaches, this combined strategy offers enhanced safety, reduced invasiveness, and improved long-term prognosis, providing a promising pathway for addressing high-risk HCC cases involving complex vascular anatomy.
CASE PRESENTATION:
The patient, a 75-year-old female, presented with a recent diagnosis of a liver tumor. A CT scan performed at an external hospital revealed a space-occupying lesion in the S8 segment, raising concerns about primary hepatocarcinoma. No significant family history of liver disease or cancer was reported. The patient was a non-smoker with no history of alcohol consumption. The patient was retired and lived in an urban area with access to healthcare facilities. No history of chronic liver diseases such as hepatitis or cirrhosis. The patient reported hypertension managed with medication and no history of diabetes or cardiovascular disease. No previous abdominal surgeries. The patient was asymptomatic, with no complaints of abdominal pain, jaundice, weight loss, or fatigue. Physical examination showed&#160;abdomen soft and non-tender, no palpable masses or organomegaly, and no signs of ascites or peripheral edema. The patient had not undergone any treatmentsprior to this admission.
Diagnosis, Assessment, and Plan: 
The initial diagnosis of hepatocellular carcinoma (HCC) was made based on imaging findings and elevated alpha-fetoprotein (AFP) levels. The patient was staged as IB (pT1N0M0) according to the AJCC 8th Edition guidelines8. A treatment plan was established to include two cycles of neoadjuvant therapy, consisting of targeted therapy, immunotherapy, and hepatic arterial infusion chemotherapy (HAIC), to reduce tumor size and ensure operability. The patient was then scheduled for laparoscopic anatomical right anterior sectionectomy. After physical examination, the blood pressure was 130/80 mmHg, heart rate: 75 bpm, respiratory rate: 18 breaths/min, and temperature: 36.8 &#176;C. The abdomen showed no visible distension or abnormal vascular patterns, and the liver and spleen were not palpable. No signs of cachexia or malnutrition were found. Skin and sclera were non-icteric. No spider angiomas or palmar erythema were observed.

<table><tbody><tr><td>Absorbable Suture (Vicryl)</td><td>Johnson &amp;amp; Johnson</td><td>V-348</td><td></td></tr><tr><td>Anesthesia Gas (N2O + O2)</td><td>Airgas</td><td>N2O/O2</td><td></td></tr><tr><td>General Anesthesia Drugs</td><td>Roche</td><td>Propofol</td><td></td></tr><tr><td>Non-absorbable Suture (Prolene)</td><td>Ethicon</td><td>PROLENE 8698</td><td></td></tr><tr><td>Povidone Iodine Solution</td><td>Betadine</td><td>BP-500</td><td></td></tr><tr><td>Surgical Forceps</td><td>Surgical Instruments</td><td>SIC-925</td><td></td></tr><tr><td>Surgical Scissors</td><td>Aesculap</td><td>KLS Martin 5245</td><td></td></tr><tr><td>Surgical Sterile Drapes</td><td>3M</td><td>Surgical Drapes</td><td></td></tr><tr><td>Titanium Clips</td><td>Medtronic</td><td>Endo GIA</td><td></td></tr><tr><td>Ultrasonic Scalpel</td><td>Ethicon</td><td>Harmonic ACE+</td><td></td></tr></tbody></table>

laparoscopic anatomical resection of the right anterior lobe based on the laennec capsule technique

Laparoscopic Anatomical Resection of the Right Anterior Lobe Based on the Laennec Capsule Technique

This paper presents a laparoscopic anatomical resection technique for hepatocellular carcinoma (HCC) utilizing the Laennec capsule concept. The goal of this protocol is to improve surgical precision and safety during complex liver resections, particularly in tumors closely associated with vital vascular structures, by ensuring clear identification and dissection of critical anatomical landmarks. Surgical resection remains the primary curative treatment for hepatocellular carcinoma (HCC), but laparoscopic anatomical right anterior sectionectomy becomes particularly challenging when tumors are closely associated with major vascular structures, as this increases the risk of significant bleeding. Comprehensive preoperative treatment, including targeted therapy, immunotherapy, and hepatic arterial infusion chemotherapy (HAIC), can reduce tumor size and improve surgical outcomes, making previously borderline resectable tumors operable. In this case, a 75-year-old patient with a tumor in segment 8 (S8) of the liver, closely associated with major vascular structures, underwent two cycles of preoperative treatment. This reduced the tumor size from 6 cm by 5 cm to 4.5 cm by 3.1 cm. Laparoscopic anatomical right anterior sectionectomy was performed using the Laennec capsule, an anatomical structure that aids in vascular dissection. The procedure lasted 240 minutes with minimal blood loss (200 mL). The tumor was successfully resected with negative surgical margins, and the patient was discharged on the seventh postoperative day without complications. Postoperatively, the patient was monitored for signs of liver dysfunction and underwent routine imaging to assess for recurrence. Follow-up included liver function tests and regular CT scans, showing no recurrence after 6 months. This case demonstrates that the combination of the Laennec capsule technique and comprehensive preoperative treatment allows for precise, minimally invasive resections of HCC tumors closely associated with vascular structures, providing a safe and effective solution to challenging liver tumors with minimal intraoperative complications and promising postoperative outcomes.

For the protocol described here, the patient, a 75-year-old asymptomatic female, presented with an incidentally detected liver mass. Her medical and surgical history was unremarkable, except for hypertension. Physical examination and vital signs were within normal limits. Further diagnostic evaluations, including imaging and laboratory tests, were conducted to confirm the diagnosis and plan treatment.
On April 23, 2023, further CT and EOB-MR scans confirmed a tumor located in the S8 segment, a...

This protocol describes a laparoscopic anatomical right anterior sectionectomy utilizing the Laennec capsule concept, combined with comprehensive preoperative therapy. The approach enables precise tumor resection in hepatocellular carcinoma (HCC) cases closely associated with major vascular structures, improving surgical safety, efficacy, and long-term patient outcomes.

This paper presents a laparoscopic anatomical resection technique for hepatocellular carcinoma (HCC) utilizing the Laennec capsule concept. The goal of ...

To begin access the surgical site and fully mobilize the right liver ligaments. Then use intraoperative ultrasound to determine tumor boundaries and visualize the hepatic veins, portal veins, bile ducts, and hepatic arteries. Place the high frequency ultrasound probe at appropriate liver regions to assess tumor size, shape, and its anatomical relationships.Now mark the resection margins on the liver surface using electrocautery. Use color doppler ultrasound to assess blood flow in hepatic veins, portal veins and hepatic arteries for accurate structure identification and injury prevention. Monitor the tumor's vascularity and proximity to major blood vessels in real time using imaging.Next, apply the Pringle maneuver using a vascular tape to occlude the hepatoduodenal ligament and maintain the occlusion in 15 minute intervals followed by five minute reperfusion periods. To separate the right anterior Glissonian pedicle using Laennec's membrane and bluntly separate the left edge of the gallbladder plate from the root of the Glissons pedicle at Gate 4. Now, separate the right edge of the gallbladder plate above the Rouviere's groove at Gate 5 and dissect the right anterior lobe which includes segments 5 and 8 along the line connecting Gate 4 and Gate 5.Expose the gallbladder to dissect it using an ultrasonic scalpel. Then set the ultrasonic scalpel to an appropriate frequency and power level. Use it to separate the gallbladder from the liver bed, simultaneously cutting tissue and sealing small blood vessels to reduce bleeding.Now carefully isolate the cystic duct and cystic artery. Divide both using the ultrasonic scalpel and secure any bleeding vessels with clips. Once the gallbladder is completely detached, remove it from the abdominal cavity through the incision.After removing the gallbladder, perform another intraoperative ultrasound to identify and mark the tumor boundaries and the surface projections of the middle hepatic vein, right hepatic vein, and right anterior liver pedicle. Then use ICG mediated near-infrared imaging to confirm the tumor margins. Occlude the right anterior liver pedicle using a 7-0 suture to stop blood flow to segments 5 and 8.Then inject 0.5 to one milligram per kilogram of ICG intravenously about 15 to 30 minutes before the resection begins. During surgery, visualize ICG uptake using a near-infrared fluorescence camera. Observe that the right anterior lobe shows no fluorescence, clearly defining the resection boundary.Now incise the liver capsule along the middle hepatic veins course and identify small hepatic vein branches. Use non-energy instruments like forceps and suction to separate tissue along the plane between Laennec's capsule and the vein, then clamp and cut the veins on the resection side. Transect the liver parenchyma with an ultrasonic scalpel.Continue separating the tumor using laparoscopic dissecting forceps. Dissect along the cephalic side of the middle hepatic vein until both the right and middle hepatic vein roots are fully exposed. Dissect tissue around the right anterior hepatic pedicle and transect it with a stapler before transecting the liver parenchyma between the right anterior and posterior lobes.Confirm that the tumor remains closely adherent to the right hepatic vein but does not invade it. Then using blunt dissection and suction, separate the tumor from the right hepatic vein along Laennec's capsule. Clamp tributary veins on the resection side and use an energy device to complete liver transection.Finish the right anterior lobe resection, preserving both hepatic veins and place the resected liver specimen in a sterile bag. Now irrigate the abdominal cavity with sterile distilled water and inspect the surgical site for bleeding, bile leaks, or gastrointestinal injury before placing drains at the liver cut surface and gallbladder fossa. The surgery was completed in 240 minutes with 200 milliliters of intraoperative blood loss, and the patient showed recovery signs within 24 hours by passing gas and starting a liquid diet after one day.The patient had no postoperative complications such as bleeding, bile leakage, abdominal infection, or incision infection, and was discharged after seven days. Histopathological examination confirmed moderately to poorly differentiated hepatocellular carcinoma with 76%tumor necrosis and clear resection margins. Six month follow-up using liver function tests and CT scans showed no signs of tumor recurrence.

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Here we present a step-by-step protocol for conducting laparoscopic anterior right hepatectomy and compare its clinical effects and postoperative outcomes with those of conventional hepatectomies. Analysis of the data of 82 patients with hepatocellular carcinoma revealed that laparoscopic anterior right hepatectomy had better clinical outcomes and survival rates than the conventional hepatectomy.

Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience

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Intrahepatic cholangiocarcinoma of the caudate lobe is a challenge for many surgeons due to its unique location. Here, we present a protocol to show the step-by-step details of laparoscopic left hemihepatectomy combined with caudate lobe resection for cholangiocarcinoma.

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To evaluate the clinical benefits of laparoscopic right hemihepatectomy via the in situ anterior approach, emphasizing its advantages in minimizing tumor dissemination risks, reducing bleeding, and enhancing surgical safety, particularly for complex liver tumors.

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Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection

Human pluripotent stem cells (hPSCs) have the potential to treat a myriad of different diseases.  The utility of these cells lies in the fact that they can differentiate into any cell type in the body.  Here we describe the teratoma assay, which is used to demonstrate the pluripotence of hPSCs.

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A high incidence of tumor recurrence after resection of liver metastases remains an unsolved problem. The illustrated mouse model may be useful to investigate the reasons for such recurrences. It combines a liver resection model with intrahepatic tumor cell injection for the first time.

The Influence of Liver Resection on Intrahepatic Tumor Growth

The goal of this protocol is to describe in detail the technique of minimally invasive aortic valve replacement through a right anterior mini-thoracotomy and central aortic cannulation. This technique can potentially enhance patients' comfort and, by reducing post-operative morbidity, promote lowering the length of stay and global costs.

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Learn laparoscopic anatomical resection of the right anterior lobe using the Laennec capsule technique for hepatocellular carcinoma. This protocol combines intraoperative ultrasound and ICG imaging to improve surgical precision and patient outcomes.

Laparoscopic Anatomical Resection of the Right Anterior Lobe Based on the Laennec Capsule Technique

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