Annals of Surgical Oncology

, Volume 24, Issue 2, pp 554–555 | Cite as

Laparoscopic Right Hepatectomy: Toward Protocolization and Simplification

  • Sung Hoon Choi
  • Gi Hong ChoiEmail author
  • Dai Hoon Han
  • Sung Won Kwon
  • Jin Sub Choi
Hepatobiliary Tumors



Major hurdles for laparoscopic right hepatectomy (LapRH) include difficulties in (1) mobilization and (2) applying hanging maneuver and (3) lack of experienced assistants. We discuss the protocolization of lapRH, introducing our simplified technique.


The procedure was disassembled into six steps: (1) curtailed mobilization of the right liver so as to align the resection plane with the laparoscopic camera view, (2) inflow vascular control, (3) setting up the parenchymal resection applying the rubber band retraction method, (4) parenchymal resection approaching the caudate lobe, (5) a lifting-up maneuver using a laparoscopic grasper or retractor instead of the hanging maneuver, and (6) completion of resection dividing the caudate lobe, right hepatic vein, and remaining ligament.


Between March 2014 and August 2015, 13 LapRH surgeries were attempted. The patients consisted of eight males and five females with a mean age of 58.5 ± 11.6 years. Final pathological diagnoses were hepatocellular carcinoma in seven patients, intrahepatic duct stone in 4, and colorectal liver metastasis in 2. The mean total operative time was 381 ± 66 minutes, and the mean intraoperative estimated blood loss was 633 ± 619 ml. One patient was converted to open surgery. There was no clinically significant complication, and the mean length of stay after surgery was 9.1 ± 2.3 days.


Protocolization and simplification of the procedure may allow professionals to better understand the respective process and determine appropriate port placements, resulting in safe and successful minimally invasive hepatectomy procedures.

Supplementary material

Supplementary material 1 (WMV 248697 kb)


  1. 1.
    Choi SH, Choi GH, Han DH, Choi JS. Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases. Surg Endosc. 2015;29:387–97.CrossRefPubMedGoogle Scholar
  2. 2.
    Choi GH, Choi SH, Kim SH, Hwang HK, Kang CM, Choi JS, Lee WJ. Robotic liver resection: technique and results of 30 consecutive procedures. Surg Endosc. 2012;26:2247–58.CrossRefPubMedGoogle Scholar
  3. 3.
    Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2, 804 patients. Ann Surg. 2009;250:831–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Hilal MA, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW. Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg. 2011;15:818–23.CrossRefPubMedGoogle Scholar
  5. 5.
    Palanisamy S, Sabnis SC, Patel ND, et al. Laparoscopic major hepatectomy—technique and outcomes. J Gastrointest Surg. 2015;19:2215–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Lin NC, Nitta H, Wakabayashi G. Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg. 2013;257:205–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Tzanis D, Shivathirthan N, Laurent A, et al. European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci. 2013;20:120–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G. Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg. 2016;263:761–77.CrossRefPubMedGoogle Scholar
  9. 9.
    Brown KM, Geller DA. What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg. 2016;20: 1065–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Geller DA. The hanging maneuver facilitates laparoscopic right hepatectomy. Ann Surg Oncol. 2014;21:3717–8.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Sung Hoon Choi
    • 1
  • Gi Hong Choi
    • 2
    • 3
    Email author
  • Dai Hoon Han
    • 2
  • Sung Won Kwon
    • 1
  • Jin Sub Choi
    • 2
  1. 1.Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical CenterCHA UniversitySeongnamKorea
  2. 2.Division of Hepatobiliary and Pancreas, Department of SurgeryYonsei University College of MedicineSeoulKorea
  3. 3.Department of SurgeryYonsei University Health SystemSeoulKorea

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