Application of the Laennec membrane-based intrasheath dissection of the hepatic veins in laparoscopic anatomic hepatectomy

XI Shi-hang, SHEN Zheng-chao, WANG Guan-nan, JIANG Ya-qi, QIAN Dao-hai, FANG Xiao-san, Muhammad Danish irshad, WANG Xiao-ming

Chinese Journal of Practical Surgery ›› 2026, Vol. 46 ›› Issue (7) : 969-975.

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Chinese Journal of Practical Surgery ›› 2026, Vol. 46 ›› Issue (7) : 969-975. DOI: 10.19538/j.cjps.issn1005-2208.2026.07.19

Application of the Laennec membrane-based intrasheath dissection of the hepatic veins in laparoscopic anatomic hepatectomy

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Abstract

Objective To preliminarily explore the efficacy and safety of the Laennec membrane-based intrasheath dissection of the hepatic veins in laparoscopic anatomic hepatectomy. Methods This retrospective analysis examined the clinical data of 104 patients who underwent laparoscopic anatomic hepatectomy and were consecutively admitted to Ward 2 of the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical University (Yijishan Hospital) between September 2023 and February 2026. Among these, 48 patients underwent laparoscopic anatomic hepatectomy using the intra-hepatic vein sheath dissection technique (intrasheath dissection of the hepatic veins group), while 56 patients underwent conventional laparoscopic anatomic hepatectomy (conventional group). Baseline data, surgery-related parameters, and postoperative outcomes were recorded and compared between the two groups. Results Both groups of patients successfully underwent surgery; the conversion rate to open surgery was 6.3% in the intra-sheath group and 7.1% in the conventional group. In the intrasheath dissection of the hepatic veins group, 15 cases of isolated hepatic segment resection were performed (4 cases of segment 4, 5 cases of segment 7, and 6 cases of segment 8), and 33 cases of combined hepatic segment resection were performed (8 cases of left hepatic hemispherectomy, 6 cases of right anterior lobe resection, 7 cases of right posterior lobe resection, 6 cases of right hepatic hemispherectomy, 4 cases of right posterior lobe plus dorsal segment of the right anterior lobe resection, and 2 cases of middle hepatic lobe resection); in the conventional group, 16 cases underwent isolated segmental resection (4 cases of segment 4, 9 cases of segment 7, and 3 cases of segment 8), and 40 cases underwent combined segmental resection (11 cases of left hepatic hemispherectomy, 4 cases of right anterior lobe resection, 11 cases of right posterior lobe resection, 8 cases of right hepatic hemispherectomy, and 6 cases of middle hepatic lobe resection); with no statistically significant differences between the groups (P>0.05). The intrasheath dissection of the hepatic veins group had shorter operative times, fewer Pringle maneuvers, shorter occlusion times, and lower intraoperative blood loss compared to the conventional group, and these differences were statistically significant (P<0.05); additionally, 2 cases of air embolism occurred in the intrasheath dissection of the hepatic veins group, compared to 1 case in the conventional group. There was no statistically significant difference in liver function between the two groups on the first postoperative day; regarding postoperative complications, 6 patients in the intrasheath dissection of the hepatic veins group experienced Clavien-Dindo Grade III or lower complications, 5 cases of Grade Ⅲ and Ⅳ complications; in the conventional group, 7 patients experienced Clavien-Dindo Grade Ⅲ or lower complications, and a total of 7 cases of Grade Ⅲ and Ⅴ complications; there was no statistically significant difference between the groups. The postoperative length of hospital stay was (9.3±4.0) days in the intrasheath dissection of the hepatic veins group and (10.1±4.4) days in the conventional group. All patients had negative pathological margins. Conclusion The use of intrasheath dissection of the hepatic veins for laparoscopic anatomic hepatectomy is safe and effective, and can shorten operative time and reduce intraoperative blood loss. However, effective control of central venous pressure is required.

Key words

Laennec membrane / intrasheath dissection of the hepatic veins / anatomic hepatectomy

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XI Shi-hang , SHEN Zheng-chao , WANG Guan-nan , et al . Application of the Laennec membrane-based intrasheath dissection of the hepatic veins in laparoscopic anatomic hepatectomy[J]. Chinese Journal of Practical Surgery. 2026, 46(7): 969-975 https://doi.org/10.19538/j.cjps.issn1005-2208.2026.07.19

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Footnotes

利益冲突 所有作者均声明不存在利益冲突

Funding

Anhui Provincial Natural Science Research Project for Higher Education Institutions(2023AH040254)
Anhui Provincial Special Project for Translational Clinical Medical Research(202427b10020039)
Wu Jieping Medical Foundation Special Research Project(320.6750.2024-6-110)
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