Surgical Endoscopy

, Volume 27, Issue 8, pp 2721-2726

First online:

Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care

  • Giulio BelliAffiliated withS. Maria Loreto Nuovo Hospital, General and Hepato-Pancreato-Biliary Surgery Email author 
  • , Brice GayetAffiliated withDepartment of Digestive Diseases, Institut Mutualiste Montsouris, University Paris V
  • , Ho-Seong HanAffiliated withDepartment of Surgery, Seoul National University Bundang Hospital
  • , Go WakabayashiAffiliated withIwate Medical University, Surgery Keio University
  • , Ki-hun KimAffiliated withDivision of Hepatobiliary Surgery and Liver Transplantation, University of Ulsan College of Medicine and Asan Medical Centre
  • , Robert CannonAffiliated withDivision of Surgical Oncology, Department of Surgery, University of Louisville
  • , Hironori KanekoAffiliated withDepartment of Surgery, Toho University School of Medicine
  • , Thomas GamblinAffiliated withDivision of Surgical Oncology, Medical College of Wisconsin
  • , Alan KoffronAffiliated withWilliam Beaumont Hospital
    • , Ibrahim DagherAffiliated withS. Maria Loreto Nuovo Hospital, General and Hepato-Pancreato-Biliary SurgeryDepartment of Digestive and Minimally Invasive Surgery, AP-HP, Antoine Béclère Hospital
    • , Joseph F. BuellAffiliated withS. Maria Loreto Nuovo Hospital, General and Hepato-Pancreato-Biliary SurgeryDepartment of Surgery, Tulane University School of Medicine
    • , International Consensus Group for Laparoscopic Liver Surgery

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Since the inception of laparoscopic liver surgery, the left-lateral sectionectomy has become the standard of care for resection of lesions located in segments II and III. However, few centers employee laparoscopic left hemihepatectomy on a routine basis. This study evaluated the safety and efficacy of the laparoscopic left hemihepatectomy as a standard of care.


An international database of 1,620 laparoscopic liver resections was established and outcomes analyzed comparing the laparoscopic left lateral sectionectomy (L lat) to laparoscopic left hemihepatectomy (LH). All data are presented as mean ± standard deviation.


A total of 222 laparoscopic L lat and 82 LH were identified. The L lat group compared with LH group had a higher incidence of cirrhosis (27 vs. 21 %; p = 0.003) and cancer (48 vs. 35 %; p = 0.043). Tumors were larger in the LH group (7.09 ± 4.2 vs. 4.89 ± 3.1 cm; p = 0.001). Operating time for LH was longer than L lat (3.9 ± 2.3 vs. 2.9 ± 1.4 h; p < 0.001). Operative blood loss was higher in LH (306 vs. 198 cc; p = 0.003). Patient morbidity (20 vs. 18 %; p = 0.765) was equivalent with a longer length of stay (7.1 ± 5.1 vs. 2.5 ± 2.3 days; p < 0.001) for LH. Patient mortality and tumor recurrence were equivalent.


Laparoscopic left hemihepatectomy is a more technically challenging and often time-consuming procedure than a left-lateral sectionectomy. This international multi-institutional confirmed that intraoperative blood loss, complications, and conversions are more than acceptable for laparoscopic left hemihepatectomy in expert hands. Postoperative morbidity and mortality rates together with adequate surgical margins and long-term recurrence are not compromised by the laparoscopic approach.


Hemihepatectomy Left liver Laparoscopic resection