The right posterior lobe of the liver accounts for approximately 1/3 of the total liver volume, with a complex and highly variable ductal anatomy involving the first caudal branch arising from the main trunk of the posterior branch of the portal vein, the branching patterns of the tributaries of the right hepatic vein, the anatomical characteristics of the inferior right hepatic vein, and the anatomical adjacency of the right posterior lobe; these factors collectively increase the difficulty of anatomical identification and surgical manipulation. Through rational preoperative planning and intraoperative navigation, surgical risks can be effectively reduced, resection precision can be maximized, and liver function can be preserved. Laparoscopic precise resection of the right posterior region of the liver offers new insight into function-preserving and holds potential value for optimizing individualized treatment strategies and improving patient prognosis.

In 1988, Takasaki proposed a novel anatomical concept for liver surgery, suggesting that targeted pedicles could be managed en bloc through extra-sheath dissection of the first hepatic hilum—known as Glissonian pedicle transection hepatectomy. In 2017, Sugioka further systematized this approach by incorporating Laennec capsule anatomy, describing six fissures through which target pedicles could be isolated and transected during Glissonian pedicle hepatectomy. These fissures were termed the “Six Gates”. In recent years, our team has applied the “Six Gates” concept in clinical practice, achieving complete and systematic dissection of these six anatomical “Gates” to successfully perform laparoscopic Glissonian pedicle transection hepatectomy with favorable outcomes. Building on this foundation, we have expanded and refined Sugioka’s theory by introducing the “windows” concept for rapid “Gate” localization. Additionally, we identified and named two previously undefined major fissures in the first hepatic hilum: the “Seventh Gate” and the “Eighth Gate”, enabling intersegmental Glissonian pedicle dissection in these regions.

The hepatic venous system serves as the key anatomical landmark for the division and segmentation of the liver. The approach along the hepatic veins is one of the key steps to improve the accuracy and efficacy of anatomical liver resection. The detailed anatomical basis involved in liver resection via the hepatic vein approach includes the course and variations of the left, middle and right hepatic veins and their branches; the key technical points for performing liver resection via the hepatic vein approach include the approach and anatomy of the hepatic veins, exposure techniques, identification and protection of inter-segmental veins, and response to the differences between the hepatic vein drainage area and the portal vein drainage area. With the development of high-resolution multimodal navigation technology, the understanding of the portal vein drainage area and the veins between drainage areas has reached the sub-liver segment level, which will further enhance the accuracy of liver resection surgery.

The paracaval portion of the caudate lobe (PPCL), as the deepest anatomical unit of the liver, remains the ultimate challenge in hepatic surgery due to its complex vascular supply and anatomical configuration. In recent years, the promotion of the concept of portal territory-anatomic resection (PT-AR) which utilizes the tumor-bearing portal vein territory as the fundamental unit for segmental/subsegmental resection, is advancing hepatobiliary surgeons’ understanding of this region’s anatomy towards unprecedented levels of individualization and refinement. Through results of three-dimensional imaging analysis and synthesis of existing literature, this study demonstrates significant variations in PPCL vascular origins and reveals critical deviations from classical Couinaud segmentation boundaries. This study proposes a novel portal-territory classification system for PPCL, emphasizing dynamic intraoperative delineation of true portal boundaries via integration of preoperative 3D reconstruction, laparoscopic ultrasonography, and indocyanine green (ICG) fluorescence navigation. Surgical strategies based on classification-specific were developed to achieve dual objectives: complete oncological resection within target portal territories and maximal preservation of functional liver parenchyma. 

The S7/S8 segments are one of the most complex areas in liver anatomy. Laparoscopic anatomical resection of the S7/S8 segments, as the most challenging right lateral combined hepatic segmentectomy, still has blind spots and risks in surgical procedures. At present, the standard surgical approach for laparoscopic anatomical resection of the S7/S8 segments has not yet been established, and it involves many key techniques. The optimization of the surgical procedure is worthy of attention. Based on a precise understanding of the anatomy and the rational application of emerging concepts and technologies, it is expected to establish an optimized surgical procedure that considers feasibility, safety and practicality.

With the development of comprehensive treatment for hepatocellular carcinoma, conversion therapy has provided surgical opportunities for patients with unresectable hepatocellular carcinoma; however, liver resection after conversion faces the core challenge of changes in the fine anatomical structure of the liver and systemic status. It is necessary to systematically analyze the impact of conversion therapy on hepatic anatomy, as well as the difficulties and countermeasures in liver resection, from the anatomical perspective, especially the impact of future liver remnant conversion and oncological conversion therapy on the whole body and the liver. Implementing the comprehensive strategy involving precise preoperative evaluation, optimization of surgical timing, intraoperative meticulous operation, and multidisciplinary collaboration is proposed, can enhance surgical safety and oncological efficacy.

Laparoscopic liver resection has been widely applied in the field of liver surgery due to its minimally invasive advantages. During laparoscopic liver resection, accurately identifying and exposing the important anatomical landmarks within the liver is a key step to ensure surgical safety, achieve precise resection, and improve the efficiency of the surgical process. Despite the continuous development of minimally invasive surgical techniques, the accurate identification and precise exposure of the anatomical structures within the liver remain the core demonstration of the professional capabilities of hepatobiliary surgeons. Preoperative image planning, intraoperative real-time navigation technology and refined surgical operations not only optimize the surgical process but also provide feasible support for the minimally invasive approach in complex hepatectomy.

Fine hepatic anatomy is the core cornerstone for the development of precise liver surgery. Its integration with modern surgical techniques has promoted a transformation in the surgical treatment model for hepatobiliary diseases. Starting from the concept of precise surgery, the fine hepatic anatomy plays a crucial role in surgical decision-making, surgical planning and intraoperative operation. Digital surgical technology provides precise anatomical basis for preoperative planning and surgical operations of liver surgeries, bringing revolutionary changes to hepatobiliary surgery. In the future, with the development of digital and intelligent imaging technologies and their deep integration with clinical practice, precise liver surgery will move towards higher precision and better therapeutic effects.

In recent years, with the development of high-resolution imaging, three-dimensional visualization, indocyanine green fluorescence imaging, virtual reality, and augmented reality, liver anatomy has advanced from traditional macroscopic morphological description to a multi-dimensional era of individualized, microscopic, and functional fine anatomy. The latest progress in liver fine anatomy and its innovative role in surgical strategies include: (1) the evolution from Couinaud’s segmentation to individualized watershed resection based on sub-segments; (2) the re-recognition of intrahepatic anatomical spaces; (3) the transition from static anatomy to dynamic watersheds, the development of two-step hepatectomy with combined liver partition and portal vein ligation, and hepatic vein deprivation, which utilize shunt vessels to pre-regulate the watershed and preserve liver parenchyma; (4) the integration of function and morphology, the assessment of regional liver function through SPECT, MRI hepatobiliary-specific contrast agents, and other techniques; (5) the precise demarcation of tumor invasion boundaries by molecular imaging technology to reduce the positive margin rate in non-anatomical resection; (6) the promotion of fine anatomy and surgical innovation by artificial intelligence (AI). In the future, with the in-depth research of AI, molecular imaging, and hemodynamics, liver surgery will further develop towards precision, functionality, and intelligence, providing safer and more effective individualized treatment plans for patients with complex liver tumors.