Asian journal of endoscopic surgery · 2026
Tri-Scenario-Based MAICOHAN Strategy for Minimally Invasive Extended Left Hepatectomy.
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Yamamoto Yusuke, Morimura Ryo, Imamura Taisuke, Kubo Hidemasa, Shibata Rie, Inoue Hiroyuki, Kurashima Kento, Nishibeppu Keiji, Nanishi Kenji, Kiuchi Jun, Shimizu Hiroki, Arita Tomohiro, Kosuga Toshiyuki, Konishi Hirotaka, Fujiwara Hitoshi, Shiozaki Atsushi
Аннотация
BACKGROUND: Minimally invasive extended left hepatectomy (MI-ExLH) remains a technically challenging procedure that is not yet standardized.
METHODS: We retrospectively reviewed cases of minimally invasive left hepatectomy (MI-LH) and MI-ExLH performed between 2018 and 2025 at a single institution. Surgical strategies were classified into three categories according to the tri-scenario-based MAICOHAN strategy (MHV-based Assessment and Involvement/non-involvement in Caudate-hilum-dependent Optimal extended left Hepatectomy Algorithmic Navigation): (1) the cranio-dorsal or cranio-ventral approach, selected depending on the tumor-middle hepatic vein (MHV) relationship, (2) the Arantius-first or caudate lobe resection approach, chosen based on caudate lobe involvement, and (3) the liver-transection-first or left-hepatic-duct-dissection-first approach, based on the tumor-left hepatic hilum relationship. We divided the cases into two groups-the MAICOHAN strategy group (MS group) and the non-MAICOHAN strategy group (non-MS group), where procedures were and were not performed according to the abovementioned scenarios, respectively.
RESULTS: Eleven MI-LH and 12 MI-ExLH cases were included (MS group, n = 11; non-MS group, n = 12). Operative time and length of hospital stay were significantly shorter in the MS group than in the non-MS group (262 vs. 376 min, p = 0.023; 6 vs. 9 days, p = 0.016). In the subgroup analysis restricted to MI-ExLH cases, the incidence of positive surgical margins was significantly lower in the MS group (0% vs. 50%, p = 0.046).
CONCLUSION: The tri-scenario-based MAICOHAN strategy provides a practical framework that may contribute to guiding surgeons in planning and performing MI-ExLH more safely and consistently.
METHODS: We retrospectively reviewed cases of minimally invasive left hepatectomy (MI-LH) and MI-ExLH performed between 2018 and 2025 at a single institution. Surgical strategies were classified into three categories according to the tri-scenario-based MAICOHAN strategy (MHV-based Assessment and Involvement/non-involvement in Caudate-hilum-dependent Optimal extended left Hepatectomy Algorithmic Navigation): (1) the cranio-dorsal or cranio-ventral approach, selected depending on the tumor-middle hepatic vein (MHV) relationship, (2) the Arantius-first or caudate lobe resection approach, chosen based on caudate lobe involvement, and (3) the liver-transection-first or left-hepatic-duct-dissection-first approach, based on the tumor-left hepatic hilum relationship. We divided the cases into two groups-the MAICOHAN strategy group (MS group) and the non-MAICOHAN strategy group (non-MS group), where procedures were and were not performed according to the abovementioned scenarios, respectively.
RESULTS: Eleven MI-LH and 12 MI-ExLH cases were included (MS group, n = 11; non-MS group, n = 12). Operative time and length of hospital stay were significantly shorter in the MS group than in the non-MS group (262 vs. 376 min, p = 0.023; 6 vs. 9 days, p = 0.016). In the subgroup analysis restricted to MI-ExLH cases, the incidence of positive surgical margins was significantly lower in the MS group (0% vs. 50%, p = 0.046).
CONCLUSION: The tri-scenario-based MAICOHAN strategy provides a practical framework that may contribute to guiding surgeons in planning and performing MI-ExLH more safely and consistently.