Right Hepatectomy

Right hepatectomy (right hemihepatectomy) is the surgical removal of the right lobe of the liver, comprising Couinaud segments 5, 6, 7, and 8 — approximately 60–65% of the total liver volume. It is one of the most commonly performed major liver resections and is indicated for a variety of conditions including large hepatocellular carcinoma (HCC), colorectal liver metastases, intrahepatic cholangiocarcinoma, hepatic adenomas, large symptomatic haemangiomas, and as a donor operation in living-donor liver transplantation (LDLT). The right lobe graft is the standard graft used for adult-to-adult LDLT, offering sufficient hepatocyte mass for the recipient while preserving an adequate liver remnant (future liver remnant, FLR) for the donor.

Preoperative planning is critical and involves volumetric CT or MRI to calculate the FLR as a percentage of total liver volume. A minimum FLR of 25–30% is required in patients with a normal liver, increasing to 40% in those with steatosis or chemotherapy-associated liver injury, and 50% in cirrhotic livers, to prevent post-hepatectomy liver failure. When the FLR is insufficient, portal vein embolisation (PVE) of the right portal branch is performed 4–6 weeks preoperatively to induce compensatory hypertrophy of the left lobe. Intraoperative ultrasound and careful delineation of hepatic veins and bile duct anatomy are mandatory before parenchymal transection.

Right hepatectomy is performed through an open midline or right subcostal incision, or increasingly via a laparoscopic or robotic-assisted approach at high-volume centres. Parenchymal transection is performed along the principal plane (Cantlie's line) using ultrasonic dissectors, bipolar energy, and haemostatic agents, with meticulous ligation of intrahepatic bile ducts and blood vessels. The right hepatic vein is secured and divided. Complications include bile leakage, post-hepatectomy liver failure, haemorrhage, and chest complications. With experienced surgical teams and rigorous patient selection, right hepatectomy carries a low mortality (<1–3%) and excellent oncological outcomes.