Laparoscopic Left Hemihepatectomy Using the Hilar Plate-First Approach (with Video).

Abstract

Effective inflow and outflow control of the liver is essential for a safe hepatectomy. Detachment of the hilar plate is a fundamental technique in the Glissonean approach. The hilar plate is situated near the middle hepatic vein, which runs in the midplane of the liver, and serves as a landmark during hemihepatectomy. In this study, we describe the technical details and surgical outcomes of laparoscopic left hemihepatectomy using the hilar plate-first approach. The key procedures of the hilar plate-first approach included the following: (1) detachment of the hilar plate for the left Glissonean approach, (2) the middle hepatic vein approach from the hilar plate, (3) parenchymal transection along the ischemic line and middle hepatic vein, and (4) transection of the left Glissonean pedicle at the ventral aspect of the Arantius ligament. Between September 2020 and September 2021, 12 patients underwent laparoscopic left hemihepatectomy using the hilar plate-first approach. The median operation time was 227 min (range 140-350 min), and the median estimated blood loss was 82.5 ml (range 50-150 ml). The median length of postoperative hospital stay was 7 days (range 5-10 days). No major complications, including biliary complications, were observed. The hilar plate-first approach contributes to the standardization of surgical techniques for laparoscopic left hemihepatectomy. This technique is a safe and effective approach for the inflow and outflow systems of the left hemiliver.