Application of selective outflow control technique-assisted laparoscopic hepatectomy for hepatocellular carcinoma in the right posterior superior area: a case series study (with video)

BACKGROUND: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) involving the right posterosuperior area (segments 7 and 8) remains technically demanding because of the deep anatomical location of these lesions and their close relationship to the right hepatic vein (RHV) and inferior vena cava (IVC). This study evaluated the safety, technical feasibility, and perioperative outcomes of a novel stratified selective outflow control (SOC) technique developed to optimize vascular management during complex laparoscopic hepatectomy. METHODS: A retrospective analysis was performed of 22 consecutive patients who underwent SOC-assisted LLR for HCC located in the right posterosuperior area between January 2024 and January 2026. Preoperative three-dimensional (3D) reconstruction and territory-based simulation were used to guide individualized operative planning. According to the extent of venous involvement, the SOC strategy was stratified into two anatomical approaches: the RHV Occlusion method, applied to tumors involving the RHV while sparing the IVC wall, and the Total Outflow Occlusion method, reserved for tumors involving the IVC or the RHV-IVC confluence. RESULTS: All procedures were completed laparoscopically without conversion to open surgery. The median operative duration was 233.0 min, and the median estimated blood loss was 200 mL. R0 resection was achieved in all patients, with a median surgical margin of 1.5 cm. Minor postoperative complications (Clavien-Dindo grade I-II) occurred in 59.1% of patients. Major complications (grade ≥ III) were limited to 9.9% and consisted of 2 cases of grade IIIa symptomatic pleural effusion requiring percutaneous drainage, both of which resolved successfully. No perioperative mortalities or 30-day readmissions occurred. CONCLUSIONS: SOC-assisted LLR represents a safe, technically feasible, and reproducible strategy for HCC in the right posterosuperior segments. Its stratified framework enables individualized vascular control, facilitates precise R0 resection, and supports safe management of anatomically complex tumors.