Wang Jiaguo, Yuan Jingsheng, Yang Jiayin, Xu Jie
Department of General Surgery, Liver Transplant Center, West China Hospital of Sichuan University, Chengdu, China.
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
Surg Endosc. 2025 Aug 21. doi: 10.1007/s00464-025-12124-2.
While minimally invasive approaches have transformed hepatic surgery, their implementation for VIII segmentectomies continues to present technical challenges.
A retrospective analysis included 18 consecutive patients undergoing laparoscopic S8 or sub-S8 resections. We propose a surgical classification based on G8 anatomical variations and tumor characteristics. Corresponding surgical strategies were developed, incorporating real-time ICG fluorescence navigation and laparoscopic ultrasonography. Cases and the corresponding surgical strategies were classified into three types: Type I (large exophytic tumors limiting mobilization, the Glissonean approach with/without ICG negative staining); Type II (deeper tumors with single/double G8, ICG-positive staining), and Type III (deeper tumors with multiple/high-bifurcating G8 branches, the cranial approach). The tips and tricks of the three operative procedures will be introduced with video assistance in this article.
The cohort comprised Type I (n = 2), Type II (n = 4), and Type III (n = 12) cases. The overall surgical success rate was 94.4% (17/18). Success rates by type were 100% for Type I (2/2), 75% for Type II (3/4), and 100% for Type III (12/12). R0 resection was achieved in all patients (100%). Mean operative time was 179.9 ± 56.42 min, with blood loss of 208.9 ± 103.2 mL (no transfusions required). No conversions to open surgery or major complications (Clavien-Dindo ≥ III) occurred. Postoperative stay averaged 5.84 ± 2.25 days.
This framework emphasizes adaptability to anatomical heterogeneity, balancing oncological radicality with minimally invasive precision. Our initial experience demonstrates that subtype-specific strategies enhance procedural reproducibility and vascular safety in laparoscopic S8 resection, offering a structured approach to overcome this surgical challenge.
尽管微创方法已改变了肝脏手术，但将其应用于Ⅷ段肝切除术仍面临技术挑战。
一项回顾性分析纳入了18例连续接受腹腔镜S8或S8以下肝切除术的患者。我们基于G8解剖变异和肿瘤特征提出了一种手术分类方法。制定了相应的手术策略，包括实时吲哚菁绿（ICG）荧光导航和腹腔镜超声检查。病例及相应手术策略分为三种类型：Ⅰ型（外生性大肿瘤限制游离，采用Glissonean法并可选择是否进行ICG阴性染色）；Ⅱ型（较深肿瘤伴单/双支G8，ICG阳性染色），以及Ⅲ型（较深肿瘤伴多支/高位分叉G8分支，采用头侧入路）。本文将借助视频辅助介绍三种手术操作的技巧和窍门。
该队列包括Ⅰ型（n = 2）、Ⅱ型（n = 4）和Ⅲ型（n = 12）病例。总体手术成功率为94.4%（17/18）。各类型的成功率分别为：Ⅰ型为100%（2/2），Ⅱ型为75%（3/4），Ⅲ型为100%（12/12）。所有患者均实现了R0切除（100%）。平均手术时间为179.9±56.42分钟，失血量为208.9±103.2毫升（无需输血）。未发生转为开放手术或严重并发症（Clavien-Dindo≥Ⅲ级）。术后平均住院时间为5.84±2.25天。
该框架强调了对解剖异质性的适应性，在肿瘤根治性与微创精准性之间取得平衡。我们的初步经验表明，亚型特异性策略可提高腹腔镜S8切除术中手术的可重复性和血管安全性，为克服这一手术挑战提供了一种结构化方法。
