Laparoscopic Anatomic Liver Resection Using the Landmark Vein Approach for Hepatolithiasis: A Technical Note.

Laparoscopic anatomic liver resection is the optimal treatment for intrahepatic bile duct stones confined to a liver segment or lobe. However, recurrent inflammation often obscures the first hepatic hilum, making traditional dissection approaches challenging. The "Landmark Vein approach," using a major hepatic vein as a real-time intraoperative guide for the parenchymal transection plane, offers a technical strategy to facilitate precise anatomic resection in this context. This technical note demonstrates the feasibility of this approach in a patient with complex hepatolithiasis undergoing a right hemihepatectomy. We detail the critical steps: preoperative 3D reconstruction for venous mapping, intraoperative ultrasound for confirmation, and a caudal-to-cephalad parenchymal transection meticulously guided along the middle hepatic vein. This report aims to provide a structured description of the technique, highlighting its potential utility in managing hepatolithiasis with distorted hilar anatomy. While the approach may contribute to improved surgical outcomes, further studies with larger cohorts are needed to validate its broader applicability and impact.