Objective:

To evaluate the application, technical feasibility, and short-term perioperative outcomes of a structured Selective Outflow Control (SOC) technique for laparoscopic hepatectomy in patients with hepatocellular carcinoma (HCC) located in the right posterosuperior segments.

Approach:

• Patient Selection: Inclusion criteria included solitary or multifocal HCC confined to segments 7 and 8, preoperative 3D reconstruction confirming anatomical feasibility, adequate hepatic functional reserve, and specific indocyanine green retention rates. Exclusion criteria included extreme spatial restriction caused by very large tumors or severe IVC compression, inadequate hepatic reserve, and severe cardiopulmonary comorbidity.

Key Findings:

• The SOC technique provides reliable intraoperative vascular control.
• It facilitates precise extended resection in anatomically challenging cases.
• Demonstrated favorable technical reproducibility.

Interpretation:

The SOC technique addresses the challenges of laparoscopic hepatectomy for HCC in the right posterosuperior segments by integrating selective RHV occlusion with total hepatic outflow control.

Limitations:

• The study does not establish a standardized strategy for all cases of HCC in the right posterosuperior segments.
• Limited generalizability due to the specific anatomical focus and patient selection criteria.

Conclusion:

The SOC technique shows promise for improving outcomes in laparoscopic hepatectomy for HCC in complex anatomical regions.