Cranial–dorsal approach in laparoscopic anatomical left hemihepatectomy: a retrospective comparative study

Achieving a precise transection plane during laparoscopic anatomical left hemihepatectomy (LLH) remains technically demanding. This study evaluated the effectiveness and safety of a cranial–dorsal approach guided by Arantius’ ligament. In this single-center retrospective cohort (June 2023–June 2025), 54 patients undergoing LLH were analyzed. Patients were divided into cranial–dorsal (n = 18) and caudal–ventral (n = 36) groups. Outcomes included operative time, blood loss, drain removal, liver function, inflammation markers, and complications. All procedures were completed laparoscopically without conversion. The cranial–dorsal group showed shorter operative time, less blood loss, earlier drain removal, and better postoperative liver function, with lower overall complication rates (P < 0.05). The cranial–dorsal approach enables full-length middle hepatic vein (MHV) exposure, provides a precise transection plane, reduces blood loss, and facilitates early liver function recovery. It is a safe and effective technique.