Central hepatectomy: A valuable option to avoid posthepatectomy liver insufficiency in patients requiring extensive liver resection

Central hepatectomy or mesohepatectomy, defined as en-bloc anatomical resection of liver segments 4-5 and 8, is a valuable option in patients with central large or multiple liver lesions to minimize PLF caused by the loss of a considerable portion of functional liver parenchyma following extensive resections (2). Parenchyme splitting is initiated just right to the falciform ligament between the left lateral (liver segments 2-3) and left medial (liver segment 4) sections, during which inflow structures of liver segment 4 arising off of the hilar plate are ligated and divided (Video). With the last ten consecutive patients having been operated on using this technique, our approach seems safe, feasible and reproducible, resulting in low morbidity rates without occurrence of posthepatectomy liver failure.