Outcomes of bile duct-guided right hepatic inflow occlusion and extended procedures in laparoscopic liver surgery

This study aimed to assess the safety and feasibility of bile duct-guided right hepatic inflow occlusion and associated extended procedures in laparoscopic liver surgery (LLS). A cohort of 23 patients who underwent laparoscopic right hemihepatectomy, which involved laparoscopic dissection and occlusion of the right hepatic artery and right portal vein using the bile duct-guided approach (primary procedure) were included in this study. Ten additional patients with insufficient future liver remnant (FLR) volume in the left hemiliver, as determined by preoperative assessment, underwent a staged approach. In the first stage, laparoscopic right portal vein ligation (LRPVL) was performed via the bile duct-guided approach (extended procedure). Following an observation interval, and upon confirmation of sufficient hypertrophy of the left hemiliver, either laparoscopic or open right hemihepatectomy, with or without combined procedures, was performed as the second stage. All procedures were completed without major postoperative complications. In the primary procedure cohort, the mean operative duration was 4.2 ± 0.4 h, the mean right hepatic portal occlusion time was 18 ± 8 min, intraoperative blood loss ranged from 200 to 400 ml, and the length of hospital stay was 7–12 days. For the first-stage extended procedure, the mean operative duration was 1.2 ± 0.3 h, the mean right portal vein occlusion was 14 ± 5 min, intraoperative blood loss ranged from 20 to 80 ml, and the length of hospital stay was 3–5 days. The second-stage procedure was performed 3 to 5 days after the most recent three-dimensional imaging assessment. The mean left liver volume increased from 456.14 ± 84.42 cm3 before the first-stage procedure to 649.06 ± 102.26 cm3 before the second-stage procedure, corresponding to a 44 ± 18% increase. Bile duct-guided right hepatic inflow occlusion and its extended procedures demonstrated safety and feasibility in the context of LLS.