Introduction to Minor Hepatectomy
Zoë Pironet
Mathieu D’Hondt
Laparoscopic surgery for liver resection (LLR) has evolved tremendously over the last decades.
In 1992 Gagner et al reported the first case of laparoscopic liver resection (1).
Since then, laparoscopy has been increasingly used for liver surgery. The first cases of laparoscopic left segmentectomy (LLS) were reported in 1996 by Azagra et al and Kaneko et al. (2, 3). As the experience in laparoscopy for minor liver resections expanded, multiple studies documented on the feasibility and safety of these procedures, making laparoscopy progressively an approach of choice (4-7).
A minor liver resection is defined as the resection of 2 or fewer Couinaud segments.
Generally, left lateral sectionectomies or resections of anterolateral segments (2, 3, 4b, 5 and 6) are considered minor resections, while laparoscopic resections of the posterior superior segments (1, 4a, 7, 8) are regarded major resections. (8-9)
This distinction is made based on several advantages of the resection of anterolateral segments compared to the resection of posterosuperior segments. The laparoscopic accessibility of the anterolateral segments is convenient in supine position with ports below costal arch level.
Furthermore the rather small transection planes are vertical in supine position and thus readily accessible. (10)
Several benefits of laparoscopic minor liver resections have been demonstrated compared to open surgery. (11-14)
First, laparoscopic approach is associated with less blood loss and less need for transfusion.
A second benefit is a faster functional recovery with a shorter mean length of ICU stay and shorter mean length of hospital stay.
Thirdly, the incidence of postoperative complications is significantly lower, especially for high grade complications. In addition, the oncological results tends to be comparable for laparoscopic and open approach.
In 2008 the Louisville consensus meeting stated that the laparoscopic approach to left lateral sectionectomy should be considered the standard of care. (8) A follow-up to this consensus meeting was the second International Consensus Conference was held in Morioka in 2014. Here the newer data reinforced the recommandation to regard laparoscopy for minor liver resections as standard practice. (9) These findings were validated in the Southampton Consensus Guidelines in 2017. (15)