Types of Right or Left Hepatectomy

Liver surgery is one of the most intricate and significant procedures in hepatobiliary medicine. Among these surgeries, Types of Right or Left Hepatectomy surgery are commonly performed for treating liver diseases, tumors, and certain benign conditions. Hepatectomy refers to the surgical removal of a portion of the liver. Depending on the location and extent of the disease, surgeons may choose to remove either the right or the left lobe of the liver.

What is a Hepatectomy?

A hepatectomy is a surgical procedure to remove all or part of the liver. The human liver is divided into two main lobes the right lobe and the left lobe which are further divided into segments based on the Couinaud classification. Surgeons use this classification to determine exactly which part of the liver needs to be removed, ensuring that enough healthy liver tissue remains for the organ to function properly after surgery.

Indications for Hepatectomy

Hepatectomy is typically performed in the following situations:

• Primary liver cancer (like hepatocellular carcinoma)
• Secondary liver metastases (especially from colorectal cancer)
• Benign tumors such as hepatic adenomas or large hemangiomas
• Liver trauma or injury
• Liver donation for transplantation

Depending on the tumor’s location and size, either a right or left hepatectomy is chosen. Each type can be further classified based on the extent of liver resection.

Types of Right or Left Hepatectomy Surgery

Hepatectomies are categorized based on the anatomical location and volume of liver removed. Below are the most common types of right and left hepatectomies:

1. Standard Right Hepatectomy (Right Lobectomy) :- This involves the removal of segments V, VI, VII, and VIII, which make up the right lobe of the liver. It is typically performed when tumors or lesions are localized in the right lobe.
   • Mobilization of the right liver
   • Control of inflow (right hepatic artery and portal vein)
   • Control of outflow (right hepatic vein)
   • Parenchymal transection along the Cantlie line (imaginary line dividing liver into functional right and left halves)

   Common indications

   • Right lobe tumors
   • Large hemangiomas or cysts
   • Right-lobe metastases
2. Extended Right Hepatectomy (Right Trisectionectomy) :- In this more extensive resection, segments IV, V, VI, VII, and VIII are removed. This includes the entire right lobe plus a portion of the medial left lobe (segment IV).
   • Large tumors crossing the middle hepatic vein or extending into segment IV
   • Metastatic disease involving both the right lobe and segment IV

   Surgical note: Due to the removal of additional tissue, this type requires careful assessment of liver function and remnant liver volume before surgery.

3. Standard Left Hepatectomy (Left Lobectomy) :- This procedure removes segments II, III, and IV, which comprise the left lobe of the liver.
   • Isolation and ligation of the left hepatic artery, left portal vein, and left hepatic vein
   • Transection along the Cantlie line

   Indications

   • Left lobe hepatocellular carcinoma
   • Cysts or adenomas in the left lobe
   • Cholangiocarcinoma located near the left hepatic duct

   Advantages

   • Generally safer in patients with limited liver function, as the right lobe is larger and left intact
4. Extended Left Hepatectomy (Left Trisectionectomy) :- This involves the removal of segments II, III, IV, V, and VIII. Essentially, this includes the entire left lobe and part of the right anterior segments.
   • Tumors that span the midline or encroach upon both left and right lobes
   • Cholangiocarcinoma with extensive biliary involvement

   Risks

   • Greater risk of post-operative liver insufficiency if not enough liver remnant remains
5. Central Hepatectomy (Mesolobectomy) :- Also known as a segmentectomy of segments IV, V, and VIII, this surgery removes the central liver tissue while preserving the peripheral segments.
   • When tumors are located centrally but do not involve the portal pedicles of the right or left lobe
   • Avoids extended resection and preserves more liver tissue

   Advantages

   • Preserves both lateral segments (II, III, VI, VII)
   • Reduces the risk of liver failure by conserving functional liver tissue
6. Non-Anatomical or Wedge Resection :- Though not technically a right or left hepatectomy, wedge resection involves removing small tumors without strictly following segmental anatomy.
   • Small peripheral lesions
   • Patients with poor liver function (e.g., cirrhosis) who cannot tolerate major hepatectomy

   Limitation

   • Higher risk of recurrence compared to anatomical resections

Factors Influencing the Choice of Hepatectomy

Several critical considerations determine the type of hepatectomy a surgeon may perform:

• Location and size of the tumor
• Presence of cirrhosis or fatty liver disease
• Future liver remnant volume (FLR)
• Liver function tests (e.g., Child-Pugh Score, MELD Score)
• Vascular and biliary involvement
• Preoperative imaging and 3D mapping

Advanced imaging techniques like CT volumetry, MRI, and intraoperative ultrasound play a vital role in preoperative planning.

Postoperative Recovery and Outlook

Recovery after hepatectomy depends on:

• The type and extent of resection
• Preoperative liver health
• Surgical approach (open vs. laparoscopic)

Typical recovery timeline:

• Hospital stay :- 5 to 10 days (can vary)
• Full recovery :- 6 to 8 weeks
• Laparoscopic approaches may reduce downtime

Complications to monitor

• Bile leaks
• Post-hepatectomy liver failure (PHLF)
• Bleeding or infection

With proper surgical planning and post-op care, most patients regain full liver function, as the liver has remarkable regenerative capacity.

Conclusion

Understanding the types of right or left hepatectomy is essential for patients and caregivers dealing with liver-related diseases. Each type of hepatectomy is tailored to remove diseased tissue while preserving as much healthy liver as possible. Surgical advancements and improved preoperative planning have significantly enhanced outcomes and reduced risks.

Whether you’re facing surgery for a liver tumor, trauma, or donating part of your liver, knowing the type of hepatectomy being considered will help you make informed decisions and prepare for recovery. Consult a hepatobiliary surgeon to determine the most appropriate surgical plan for your condition.