Left Hepatectomy

Left hepatectomy (left hemihepatectomy) is the surgical resection of the left lobe of the liver, encompassing Couinaud segments 2, 3, and 4 — typically constituting 30–40% of total liver volume. It is indicated for tumours, metastases, cholangiocarcinoma, or benign lesions predominantly involving the left lobe, as well as in left-lobe living-donor liver transplantation (particularly for paediatric recipients, where a smaller graft from an adult donor is sufficient). Left hepatectomy is generally a less physiologically demanding operation than right hepatectomy, as the residual right lobe (segments 5–8) represents a larger remnant with greater functional reserve.

Preoperative assessment includes high-quality CT or MRI volumetry to confirm adequate future liver remnant (FLR), review of hepatic vascular and biliary anatomy, and assessment of underlying liver health. In living-donor left hepatectomy, the procedure is adapted to ensure safe procurement of the left lobe graft with meticulous attention to the middle hepatic vein, left hepatic artery, left portal vein, and left hepatic duct — all of which must be preserved with adequate lengths and protected from injury. Detailed 3D vascular reconstructions and intraoperative cholangiography are integral to planning.

Surgical technique involves transection along the principal liver plane (right of the falciform ligament for left hepatectomy), with careful haemostasis of parenchymal vessels and bile radicals using energy devices and clips. The left hepatic vein is divided at the caval confluence. In laparoscopic or robotic approaches — increasingly used at expert centres like ours — the operation is performed through small ports with magnified visualisation, resulting in reduced blood loss, shorter hospital stay, and faster recovery. Our surgeons at Ahmedabad Liver Surgeons perform both open and minimally invasive left hepatectomies with consistently excellent outcomes.