Figure 2.

Schema of the caudal approach for laparoscopic posterior sectionectomy with prior transection without mobilization in the left lateral position. Stars denote the tumor in the posterior section of the liver. The left image shows the organ pre-transection, and the right image shows the organ during transection. The transection was performed in one direction from the caudal edge of the liver, with exposure of the inferior vena cava (IVC) and the right hepatic vein on the cutting plane (arrow head, right). This procedure facilitates exposure of the cutting plane (thick arrow, right) between the retroperitoneal-fixed resected liver and the remnant liver, which has fallen downward by gravity (thin arrow, right). The decreased venous pressure in the right hepatic vein, vertically standing up from the IVC, leads to decreased intraoperative bleeding. Finally, the oncological benefit is the same as the anterior approach in open right hepatectomy.