Laennec approach for anatomical liver resection assisted by laparoscopy or robotics: a multicenter cohort study

Introduction: Laennec’s capsule serves as a critical anatomical landmark in liver resection. Despite its potential, a lack of large-scale prospective studies limits the widespread use of the Laennec approach for minimally invasive hepatectomy. This multicenter cohort study aimed to compare the outcomes of the traditional and Laennec approaches in minimally invasive anatomical hepatectomy across multiple centers in China. Methods: A total of 445 patients from 11 centers were included, with 339 undergoing the Laennec approach and 106 receiving the traditional approach. Intraoperative parameters such as the duration of hepatic pedicle isolation, hepatic vein exposure, parenchymal transection, and liver mobilization were analyzed. Postoperative outcomes, including recurrence-free survival and R0 resection rates, were also assessed. Additionally, a series of subgroup analyses were conducted to evaluate the efficacy of the Laennec approach. Results: The Laennec approach demonstrated notable intraoperative advantages, including reduced durations for hepatic pedicle isolation, liver mobilization, hepatic vein exposure, and parenchymal transection. Robotic-assisted procedures, in particular, showed superior outcomes when compared with laparoscopic platform. The Laennec approach proved highly effective across various liver diseases, particularly hepatocellular carcinoma, hemangioma, and hepatolithiasis. The Laennec gap, a distinct gap between the liver parenchyma and surrounding vasculature, played a key role in identifying candidates for the Laennec approach. Subgroup analysis revealed that although the Laennec approach provides significant intraoperative benefits, these advantages do not seem not to translate into substantial postoperative improvements. Conclusions: The Laennec approach offers clear intraoperative advantages over the traditional approach when utilizing laparoscopic or robotic systems. These findings support the Laennec approach as a standardized technique for anatomical liver resection.