Identification of the midplane by temporary clamping of the right side of the hilar plate using a laparoscopic grasper (with Video).

BACKGROUND

Accurate identification of the midplane (Cantlie's line) is essential for anatomical liver resections, but conventional inflow control is often challenging because of adhesions, tumors, or anatomical variations. We developed a simple technique involving temporary clamping of the right side of the hilar plate using a laparoscopic grasper, covering at least the posterior extremity of the cystic plate anteriorly and the right half of the hepatoduodenal ligament posteriorly, for early identification of the midplane.

METHODS

This study analyzed 62 patients undergoing laparoscopic hepatectomy. Without hilar dissection, the right Glissonean pedicle was gently clamped using a laparoscopic curved grasper. Success rates of midplane demarcation were compared between patients with normal portal vein (PV) anatomy (type 1) and those with variations (types 2 and 3).

RESULTS

The overall success rate of midplane identification was 80.6% (50 of 62). Patients with a type 1 PV common trunk had a significantly higher success rate (92%, 46 of 50) than those with type 2 or 3 variations (50%, 6 of 12; P =.002). The technique was feasible in cirrhotic livers and was effective for identifying the right portal fissure in type 3 variations.

CONCLUSION

Temporary clamping of the right hilar plate is a minimally invasive and efficient method for early midplane identification. By avoiding hilar dissection, it enhances the safety and precision of anatomical liver resections.