Background : It is currently difficult to establish a retrohepatic tunnel (RT) under laparoscopy. Therefore, dissecting the third hepatic hilum before parenchymal transection is unavoidable in some cases, and it can lead to significant liver mobilization, tumor compression and bleeding of the short hepatic veins (SHVs). Here, we presented a novel technique utilizing the ventral avascular area of the inferior vena cava (IVC), a technique allowing us to address SHVs after liver parenchymal transection, thereby achieving in situ LLR.

Methods : In this novel technique, we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC. Then, we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker; subsequently, we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.

Results : A total of 44 patients were enrolled in the study. Of these 44 patients, 17 (38.6%) underwent laparoscopic right hemihepatectomy, 14 (31.8%) underwent left hemihepatectomy, 9 (20.5%) underwent posterior segment resection, and 4 (9.1%) underwent posterior and anterodorsal segment resection. The mean operative time was 178 minutes, and the mean blood loss was 286 milliliters.

Conclusions : This novel technique can reduce surgical difficulty by avoiding tumor compression and allowing for in situ removal of complex tumors in any part of the liver.