To investigate the clinical application value of two-step separation approach in laparoscopic left lateral sectionectomy (LLLS).

A total of 156 patients undergoing LLLS with two-step separation approach in Hunan Provincial People's Hospital between January 2009 and September 2014 were included in this prospective study. Among the 156 patients, 76 were males and 80 were females with the age ranging from 18 to 75 years old and the median of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were in bladder lithotomy position or straddle position and pneumoperitoneum was established with 4-hole approach and periumbilical puncture. Hepatectomy was performed using two-step separation approach. The liver parenchyma was dissected to the plane of left lateral hepatic pedicle-left hepatic vein using ultrasonic scalpel along the left of falciform ligament. Then, the hepatic pedicle and the left hepatic vein was dissected using Endo-GIA stapler.

All patients completed the surgery successfully and no case was converted to laparotomy. Eighty-nine patients underwent simple left lateral hepatic artery occlusion and 67 patients did not undergo hepatic inflow occlusion. The median operation time was 85 (53-150) min and the liver dissection time was 17 (8-35) min. The intraoperative blood loss was 25 (10-100) ml and the postoperative length of stay was 7 (5-10) d. No death case and no serious postoperative complication was observed. Only 7 patients developed mild bile leakage and recovered after effective drainage.

Two-step separation approach in LLLS is safe and easy, which can be taken as a standard operation and widely popularized.