Impact of middle hepatic vein tributary-oriented laparoscopic left hepatectomy: concept based on specific anatomical facts.

Background: Although left hepatectomy is widely adopted for hepatic lesions, the procedure still remains standardization, also in laparoscopic left hepatectomy (LLH). In this procedure, approaching middle hepatic vein (MHV) is golden standard technique as landmark of parenchymal transection. In our experience, MHV-tributary must be very close toward hilar plate by laparoscopic caudal view. In this study, we investigated the distance between hilar plate and MHV, and evaluated our LLH procedure based on specific anatomical facts.Methods: Thirty nine patients performed LLH in 2000 to 2014 are included this study. Surgery were performed with 4 to 5 trocars by lithotomy position. From axial and coronal section images of computed tomography, the distance between hilar plate toward MHV is measured in random selected patients (n=30).Results: All patients could be approached MHV-tributary in transection plane. Median of operative time and blood loss were 278 min (120-540) and 200 ml (0-1300), respectively. Postoperative complication rate (Clavien-Dindo gradeIII-IV) was 15.4 % (n=6) with no mortality. Length of hospital stay was 9.6 days. The distance between hilar plate and MHV was 9.4 mm without significant relationship of liver volume or BMI.Conclusion: This study showed that caudal approach and our MHV tributary-oriented approach for LLH was feasible.