Small skin incision left-side hepatectomy.

Although pure laparoscopic liver resection is thought to be a useful method in terms of cosmetic outcome and less invasiveness, this procedure has not yet become widespread, presumably due to its high technical demands and proficiency requirements. In order to achieve surgical safety and minimum invasiveness simultaneously, we recently implemented a small skin incision left hepatectomy technique, which is feasible in most centers not currently performing the pure laparoscopic technique. To summarize, a small skin incision of 8-10 cm is taken on the right subcostal region, and Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) is attached to appropriately expand the wound. Peanuts swabs and board-shaped spatulae are used to spread the surgical field during the procedure. The left hepatic vein, as well as the common trunk of the left-middle hepatic veins, is approached and secured by the Arantius's ligament traction method. Both manipulation of the hepatic hilum and subsequent liver parenchymal transection using the liver-hanging maneuver technique can be performed safely under direct vision. This technique would provide reasonable cosmetic results compared to the standard method, while not increasing the risk associated with pure laparoscopic hepatectomy. Therefore, we believe that this technique can be introduced immediately for experienced liver surgeons.