Laparoscopic liver resection utilizing the ventral avascular area of the inferior vena cava: A retrospective cohort study

Background: Laparoscopic liver resection (LLR) can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy. Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization, tumor compression, and bleeding from the short hepatic veins (SHVs). This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava (IVC), allowing SHVs to be addressed after parenchymal transection, thereby reducing surgical complexity and improving outcomes in in situ LLR. Aim: To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods. Methods: The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. In novel LLR, 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. The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared. Results: A total of 256 patients were included, with 150 (58.59%) undergoing conventional LLR and 106 (41.41%) undergoing novel LLR. The novel technique resulted in significantly larger tumor resections (6.47 +/- 2.96 cm vs 4.01 +/- 2.33 cm, P < 0.001), shorter operative times (199.57 +/- 60.37 minutes vs 262.33 +/- 83.90 minutes, P < 0.001), less intraoperative blood loss (206.92 +/- 37.09 mL vs 363.34 +/- 131.27 mL, P < 0.001), and greater resection volume (345.11 +/- 31.40 mL vs 264.38 +/- 31.98 mL, P < 0.001) compared to conventional LLR. Conclusion: This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression. It facilitates a safer, in situ removal of complex liver tumors, even in challenging anatomical locations. Compared to conventional methods, this technique offers significant advantages, including reduced operative time, blood loss, and improved overall surgical efficiency.