The dorsal approach to the middle hepatic vein from the hilar plate in laparoscopic hemihepatectomy (with video).

Background: Although laparoscopic hemihepatectomy has gained prominence, one of the critical challenges in this procedure is the approach to the middle hepatic vein (MHV). The MHV, which runs in the midplane of the liver, is situated above the hilar plate and serves as an anatomical landmark in hemihepatectomy. We have introduced dorsal approach to the MHV from the hilar plate in laparoscopic hemihepatectomy under the laparoscopic caudo-dorsal view.

Methods: The liver parenchyma was divided along the midplane, which was identified as a surface ischemic line caused by selective inflow control of the right or left hemiliver. The MHV is dissected from the main root from the hilar plate toward the peripheral branches. The liver parenchyma was divided from the dorsal toward the ventral side, and the transection plane was tailored according to the particular type of hemihepatectomy.

Results: This approach was utilized in 28 patients with 9 undergoing right hepatectomy and 19 undergoing left hepatectomy. The median duration of the surgery was 260 min (range, 140-360 min), whereas median estimated blood loss was 80 mL (range, 40-400 mL). One patient (3.6%) has experienced postoperative major complications. The median length of postoperative hospitalization was 7 days (range, 5-20 days).

Conclusion: In conclusion, the dorsal approach to the MHV from the hilar plate in laparoscopic hemihepatectomy represents a significant advancement in the surgical technique. This approach offers enhanced visualization and precise dissection, which are critical for minimizing complications and improving surgical outcomes.