ArticleSurgical endoscopy2025
Surgical classification of segment VIII: an anatomical model guiding tailored hepatectomy approaches (with video).
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile minimally invasive approaches have transformed hepatic surgery, their implementation for VIII segmentectomies continues to present technical challenges.
methodsA 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.
resultThe 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.
conclusionThis 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.
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