A Safe and Valid Procedure for Pure Laparoscopic Partial Hepatectomy of the Most Posterosuperior Area: The Top of Segment 7

Abstract

Although laparoscopic hepatectomy, which was first reported in the 1990s, has become widely used worldwide due to its minimal invasiveness, segments 1, 7, and 8 and the superior part of segment 4, according to the classification of Couinaud, are considered unfavorable portions for laparoscopic hepatectomy even now, due to the limited visualization and the difficulty of handling the laparoscopic devices. Especially in the most posterosuperior area (the top of segment 7), it is not easy to secure a sufficient surgical margin, even during nonanatomical resection. Recently, laparoscopic hepatectomy for lesions located in this unfavorable region has often been reported by surgeons with substantial experience; however, the surgical details have never been described adequately. We describe here our safe and valid procedure for pure laparoscopic partial hepatectomy of this poorly accessible area.