ASO Author Reflections: Laparoscopic Right Posterior Sectionectomy with Preservation of Subsegment Using Digital Intelligence Liver Surgery Technologies in Patients with HCC After Conversion Therapy

Laparoscopic right posterior sectionectomy (LRPS) is one of the most technically challenging laparoscopic hepatectomies due to the limited access, poor exposure of the posterior part of the liver, and the anatomical variations of the right posterior portal vein.¹ The typical blood inflow occlusion of this procedure is that the cranioventral aspect of the root of the posterior Glissonean pedicle is exposed and ligated by blunt dissection at the Rouviere's sulcus.² It is noteworthy that the posterior portal vein of the first (PPa) is crucial due to its proximity to the root of the right posterior Glissonean pedicle (RAGP). When the tumor is located in the right posterior section (RPS), except for the PPa territory, anatomical resection of the RPS preserving it can be scheduled. The RPGP can be ligated at the distal cutting plane of the PPa to preserve more functional liver parenchyma. However, the difficulty in identifying and dissecting targeted Glissonean pedicles remains due to the absence of tactile feedback, limited space during laparoscopy, and lack of effective intraoperative navigation assistance technology. Therefore, preserving the subsegment during LRPS may be difficult to perform, which has hindered its widespread acceptance. …