Challenges and tactics of laparoscopic anatomical hepatectomy of segment 7 / 中华消化外科杂志

ABSTRACT

Laparoscopic anatomical hepatectomy of segment 7 is recognized as one of the most difficult hepatectomies. Because of its location and anatomic characteristics, the resection of hepatic segment 7 has the difficulties of poor surgical view, instrumental accessibility, hepatic pedicle anatomy, confirmation of dividing line and secure hemostasis. When performing laparoscopic anatomical hepatectomy of segment 7, the authors routinely put patient at left semi-decubitus position, set all trocars at the right upper quadrant of the abdomen, and select proper approach for hepatic pedicle anatomy according to the results of individualized preoperative three-dimensional reconstruction. The authors use to transect the liver parenchyma at the plane between hepatic segment 6 and segment 7, with the direction perpendicular to the right hepatic vein, and then finish parenchymal dissection using right hepatic vein as the intrahepatic landmark. According to the authors experiences, choosing appropriate tactics can effectively reduce the difficulty of laparoscopic anatomical hepatectomy of segment 7, improve the safety and controllability of operation, and ensure the oncological radical effects.