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Page 8 of 15 Otsuka et al. Hepatoma Res 2021;7:5 I http://dx.doi.org/10.20517/2394-5079.2020.112

A B

Figure 9. Resection planes of totally laparoscopic hemi-hepatectomies: (A) completion of the right hemi-hepatectomy; and (B)
completion of the left hemi-hepatectomy

Table 1. Procedure and disease profiles of the performed pure laparoscopic hemi-hepatectomies
Rt. hemi-hepatectomy Lt.hemi-hepatectomy Sum
Hepatocellular carcinoma 6 (66.7%) 3 (33.3%) 9
Intrahepatic cholangiocarcinoma 2 (66.7%) 1 (33.3%) 3
Metastatic cancer 3 (75.0%) 1 (25.0%) 4
Benign to low grade malignant tumors 2 (40.0%) 3 (60.0%) 5
Sum 13 (61.9%) 8 (38.1%) 21

compare continuous variables. Statistical analysis was performed using EZR software version 1.51 . A P
[9]
value less than 0.05 was considered statistically significant.

RESULTS
During this study period, 488 liver resections were performed in our institution, including 222 cases
of laparoscopic liver resection and 266 cases of open liver resection. In laparoscopic liver resections, 94
cases were anatomical hepatectomies and 128 cases were non-anatomical partial hepatectomies. In open
liver resections, 195 cases were anatomical hepatectomies and 71 cases were non-anatomical partial
hepatectomies. In laparoscopic anatomical liver resections, 31 cases were major liver resections, which
remove more than three segments defined by Couinaud’s classification, including 25 TLHHs. In 25 TLHHs,
21 cases were performed for liver tumors, while four cases were for hepatolithiasis. In open anatomical
hepatectomies, 73 cases were major hepatectomies including 69 hemi-hepatectomies.

The 21 laparoscopic hemi-hepatectomies comprise 13 right hemi-hepatectomies and 8 left hemi-
hepatectomies. They were performed for primary or metastatic liver disease, including nine for HCC, four
for colorectal cancer metastasis, three for intrahepatic cholangiocarcinoma (ICC), and five for benign to
low grade malignancy liver tumors [Table 1].

Among these cases, 10 patients were considered as DIG, of which four cases had a tumor larger than 70 mm
(80-120 mm), three patients had tumor located adjacent to the confluences of major hepatic veins, one had
tumor invading the right adrenal gland, one suspicion of tumor invading to the right diaphragm, and one
suspicion of tumor invading the retroperitoneum. Another 11 patients were classified as FIG.