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Dorsal vs ventral approach to the middle hepatic vein during laparoscopic left hemihepatectomy: multicenter retrospective observational study

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Abstract

Background

Left hemihepatectomy requires exposure of the middle hepatic vein (MHV) at the cutting-surface. Two procedures are used to approach the MHV: a conventional ventral approach and a laparoscopy-specific dorsal approach. This multicenter retrospective observational study aimed to evaluate the perioperative outcomes of these two procedures.

Methods

Clinical records of 38 consecutive patients that underwent laparoscopic left hemihepatectomy in four university hospitals between 2016 and 2021 were retrospectively reviewed. Outcome measurements were operative blood loss, operating time, trend of postoperative laboratory data within 7 days after hepatectomy, and postoperative complications. Quality of MHV exposure was also evaluated and compared by three-grade evaluation (excellent/good/poor) using recorded still images of the cut-surface of the remnant liver (n = 35).

Results

Dorsal and ventral approaches were performed in 9 and 29 patients, respectively. Median operating time was 316 min (dorsal) and 314 min (ventral) (P = 0.71). Median operative blood loss was 45 ml (dorsal) and 105 ml (ventral) (P = 0.10). Two patients in the ventral approach group had bleeding in excess of 500 ml, which was not seen in the dorsal approach group. Excellent/good/poor MHV appearance on the cutting-surface was observed in 5/3/1 patients in the dorsal approach group, respectively, and in 7/8/11 patients in the ventral approach group, respectively (P = 0.03). In the ventral approach group, significant increases of aspartate aminotransferase (on postoperative day 1 and day 4/5) and of alanine aminotransferase (on postoperative day 2/3 and 4/5) were observed (P < 0.05). Postoperative complications were observed only in the ventral approach group (n = 3).

Conclusions

The dorsal approach could achieve safe and precise anatomical left hemihepatectomy with operation time and operative blood loss comparable to the conventional ventral approach.

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Acknowledgements

We thank Benjamin Phillis from the Clinical Study Support Center at Wakayama Medical University for proofreading and editing this manuscript. Also, we thank Drs. Takeo Nomi (Uji-Tokushukai Medical Center), Manabu Kawai (Wakayama Medical University Hospital), and Norihiko Suzaki (Kainan Iryou Center) for evaluating the landmark appearance on the cut-surface.

Funding

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Authors and Affiliations

  1. Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Masaki Ueno, Shinya Hayami & Hiroki Yamaue

  2. Department of Surgery, Shiga University of Medical Science, Otsu, Japan

    Hiroya Iida & Haruki Mori

  3. Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

    Koji Komeda & Fumitoshi Hirokawa

  4. Department of Surgery, Kansai Medical University Hirakata Hospital, Osaka, Japan

    Hisashi Kosaka & Masaki Kaibori

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  1. Masaki Ueno
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  2. Hiroya Iida
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  5. Fumitoshi Hirokawa
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Correspondence to Masaki Ueno.

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Disclosures

Masaki Ueno, Hiroya Iida, Koji Komeda, Hisashi Kosaka, Fumitoshi Hirokawa, Shinya Hayami, Haruki Mori, Masaki Kaibori, and Hiroki Yamaue have no conflicts of interest or financial ties to disclose.

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Ueno, M., Iida, H., Komeda, K. et al. Dorsal vs ventral approach to the middle hepatic vein during laparoscopic left hemihepatectomy: multicenter retrospective observational study. Surg Endosc 36, 6464–6472 (2022). https://doi.org/10.1007/s00464-021-08998-7

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