Overview
The model minimally invasive liver operation.
A partial left hepatectomy removes part of the left liver — most commonly the lateral section (segments 2 and 3, together called a left lateral sectionectomy) — without taking the entire left lobe. Single-segment resections (a segment 3 segmentectomy, for example) are also possible when the tumor is small and well placed. The principle is the same as for any parenchyma-sparing liver operation: take the disease with a clean margin and leave as much healthy liver as possible.
Left lateral sectionectomy is widely regarded as the model laparoscopic and robotic liver operation. The anatomy is reliable, the exposure is excellent, and there is no need to mobilize a large portion of the liver. Most patients spend just two to four nights in the hospital and return to most activities within a month — sometimes sooner. For colorectal liver metastases involving both sides of the liver, partial left resection can also be combined with a right-sided resection or ablation in the same operation when indicated.
Who is a candidate?
Anyone with a tumor or other lesion that sits in segments 2, 3, or 4 and can be removed with a clean margin without taking the entire left lobe. We confirm the anatomy with cross-sectional imaging, intraoperative ultrasound, and tumor-board review. Patients with cirrhosis can often tolerate this operation because so little liver is removed; patients with adenomas or focal nodular hyperplasia are referred when the lesion is symptomatic, growing, or has a worrisome appearance on imaging.
How we perform it
You are asleep under general anesthesia. We place four or five small ports for the laparoscope or robot. Intraoperative ultrasound confirms the lesion location and the segmental anatomy. The triangular ligament is divided and the left side of the liver is mobilized. Using ultrasonic dissection and energy sealing, we divide the parenchyma along the falciform ligament (for lateral sectionectomy) or along the segmental boundary, controlling the pedicle and the left hepatic vein as we go. The cut surface is checked carefully for bleeding and bile leak before closure.
Recovery
Most patients stay 2–4 days in the hospital. You walk and eat the day of or day after surgery. Pain is well controlled with a combination of nerve blocks and oral medication. We follow up at 2 weeks, repeat labs at 6 weeks, and image at 3 months. Most patients return to office work in 2 weeks and exercise in 3–4 weeks.
Why Florida Surgical
Dr. Shaw is fellowship-trained in hepato-pancreato-biliary (HPB) surgery and surgical oncology, with particular experience in minimally invasive sectionectomies and segmentectomies. Intraoperative ultrasound is used on every case to confirm anatomy in real time. For cancer cases we coordinate with medical oncology so the operation is part of a coherent treatment plan — and follow-up imaging is reviewed personally at each visit.
Frequently asked questions
What is a left lateral sectionectomy?
It is the removal of segments 2 and 3 of the left liver — the part of the left lobe that sits to the left of the falciform ligament. It is one of the safest and most reproducible liver resections and is the first choice for tumors in those segments. Living-donor pediatric transplants take this same piece of liver.
Can this be done laparoscopically or robotically?
Yes — left lateral sectionectomy is the model laparoscopic and robotic liver operation. The exposure is excellent, the dissection is anatomic, and there is no need to mobilize a large portion of the liver. We use minimally invasive technique whenever possible.
Is recovery faster than a total left hepatectomy?
Yes. Most patients go home in 2–4 days, return to light activity at one week, and resume normal work and exercise at 3–4 weeks. The smaller the resection and the more minimally invasive the approach, the quicker the recovery.
What conditions need this operation?
Common reasons are left-sided colorectal liver metastases, hepatocellular carcinoma in segments 2–4, symptomatic adenomas, focal nodular hyperplasia that has grown or causes symptoms, and selected benign tumors. Hilar bile-duct cancers needing larger resection are addressed by total left hepatectomy instead.
What are the risks?
Risks are uncommon and include bleeding, bile leak, infection, and the standard risks of anesthesia. Because so little liver is removed and the operation is well controlled anatomically, complication rates are low and post-hepatectomy liver insufficiency is essentially not a concern.