Revisiting the role of the hepatic vein in laparoscopic liver resection

Laparoscopic liver resection (LLR) has expanded to include major liver resection and systematic resection as the techniques have advanced. Regardless of the oncological significance of anatomical resection, dissection of the intersegmental plane is useful in liver resection because it makes liver dissection easier and does not leave an ischemic area. In laparoscopic surgery, the hepatic vein can be exposed with less bleeding than in open surgery because bleeding can be controlled by pneumoperitoneum pressure. Therefore, the hepatic vein is a useful indicator to guide the dissected surface and to determine the depth. However, the basic technique of exposing the hepatic vein during LLR is required. The hepatic vein root can be approached using either a cranial or dorsal approach, with the dorsal approach providing the favorable view characteristic of laparoscopy. Selecting the dissection layer with the Laennec's capsule of the hepatic vein roots in mind is also a useful technique to ensure more reliable dissection of the hepatic vein. We summarize previous reports on techniques for facilitating LLR using the hepatic vein as a guide and outline the role of each hepatic vein type. Although there are many reports of procedures using the hepatic vein as a guide, the terminology of the approach awaits standardization in the future.