Minimally Invasive Anatomic Resection of Liver Segment VIII Based on Portal Territory to Treat Hepatocellular Carcinoma

Summary

This study details laparoscopic S8 segmentectomy techniques, emphasizing the transition from partial to anatomical resection guided by portal pedicle navigation. Enhanced 3D anatomical comprehension, refined minimally invasive skills, and intraoperative ultrasound mastery improved procedural precision and safety, reducing complications while optimizing hepatic surgical outcomes through systematized anatomical resection protocols.

Abstract

Hepatectomy is the primary treatment for hepatocellular carcinoma (HCC) and is categorized into anatomical hepatectomy and non-anatomical hepatectomy based on the extent of resection. Anatomical hepatectomy utilizes the portal territory (PT) liver segment or subsegment as the basic anatomical unit, systematically resecting the tumor-bearing PT and completely removing the Glisson system that supplies and demarcates this area to enhance oncological efficacy. Non-anatomical hepatectomy follows the principle of radical oncological resection, emphasizing the removal of liver tissue more than 1 cm away from the tumor margin. With the popularization of precision surgery concepts, minimally invasive anatomical hepatectomy based on PTs has been widely applied. However, the minimally invasive resection of segment S8 of the liver is still considered one of the most challenging liver resections. We successfully performed an anatomical resection of portal territory segment S8 of the liver using intraoperative ultrasound, fluorescent laparoscopy, and Lannaec membrane dissection techniques, achieving good short-term clinical outcomes.

Introduction

Hepatocellular carcinoma, commonly known as liver cancer, is one of the most common malignant tumors in China. In 2022, there were 367,700 new cases of liver cancer in China, making it the fourth highest in terms of incidence; the number of deaths reached 316,500, making it the second leading cause of cancer-related deaths¹. Hepatectomy provides one of the best opportunities for long-term survival in patients with HCC². Liver resection can be classified into anatomic liver resection (AR) and non-anatomic liver resection (NAR) based on the extent of resection. AR involves the complete resection of anatomically independent....

Protocol

The study involving laparoscopic anatomic liver resection for Segment 8 (LALR-S8) has adhered to standard ethical practices. It received approval from the Ethics Committee of the Shenzhen People's Hospital (LL-KY-2020462). Additionally, informed written consent was obtained from each patient, ensuring that the research complies with medical ethics norms and requirements.

1. Patient selection

1. Use the following inclusion criteria:
   1. Perform LALR-S8 on patients with benign or malignant liver tumors and ensure that they undergo standard cardiopulmonary evaluations, blood tests, and biochemical assessme....

Results

Between January 2022 and December 2023, a total of 17 patients underwent hepatectomy of segment S8. Of these, seven cases involved non-anatomical resections, six cases were anatomical resections via the hepatic parenchymal approach, and four cases were portal territory anatomical resections. There were no significant differences in preoperative Child-Pugh scores, tumor size, and liver reserve function among the groups. The surgical time for the PT anatomical resection group was longer than that for the non-anatomical res.......

Discussion

The resection of segment S8 of the liver, particularly anatomical resection, remains a significant challenge¹¹. The theoretical basis of portal pedicle-based anatomic hepatectomy has yet to gain widespread acceptance within the hepatic surgical community. Consequently, hepatobiliary surgeons continue to pursue robust clinical evidence to objectively evaluate the therapeutic value of anatomic liver resection. Recent advancements in hepatic anatomical re-conceptualization, particularly regarding Lae.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Bipolar electric coagulation forceps	Mindray	Seal 7	For blood vessel coagulation and division
Fluorescence Endoscopic camera system	Mindray	R1	An endoscopic camera system with 4K fluorescence imaging
Intraoperative Ultrasonic imaging system	ALOKA	UST-5418	With the four-directional flexible linear array ultrasonic laparoscopic transducer, the intraoperative ultrasound support ultrasonic elastography, contrast ultrasound, and magnetic navigation guided puncture
Intraoperative Ultrasonic imaging system	Mindray	LAP13-4Cs	Four-directional flexible linear array ultrasonic laparoscopic transducer which supports support ultrasonic elastography and contrast ultrasound
SPSS 20.0			statistical analysis software
Ultrasonic scalpel	Johnson & Johnson	ETHICON GEN11	For blood vessel coagulation and division