Left Lateral Decubitus Positioning for Laparoscopic and Robotic Hepatectomy of the Posterior Segments

Access to the posterior hepatic segments is more challenging when using minimally invasive approach such as laparoscopic or robotic hepatectomy. Positioning the patient in full left lateral decubitus facilitates significantly the exposure and mobilization of the posterior segment and decreases back bleeding from the hepatic veins during parenchymal transection. This position, however, may result counterintuitive to the liver surgeon because it changes the classic anatomical landmarks and makes access to the hepatic hilum more difficult for inflow control during parenchymal transection. The purpose of this presentation is to show and discuss the utilization of full left lateral decubitus positioning during laparoscopic or robotic hepatectomy. A PowerPoint slide presentation with short video clips will showcase different laparoscopic and robotic partial hepatectomies of segments 7, 6 and right portion of the caudate lobe, highlighting the benefits of the left lateral decubitus positioning, how to deal with the more limited access to the hepatic hilum and the change in anatomical landmarks.