Segmentectomy
Hepatic Segmentectomy is a precise liver surgery to remove one or more anatomical segments containing tumours or lesions while preserving maximum healthy liver tissue — offering an effective surgical treatment with excellent long-term outcomes for a range of liver conditions.
Overview
Hepatic Segmentectomy is an anatomically defined liver resection that removes one or more of the eight functional segments of the liver while preserving the remaining segments and their portal pedicles. This precise approach maximises disease removal while protecting as much healthy liver as possible — particularly important in patients with underlying liver disease or cirrhosis who have limited hepatic reserve. Modern image-guided techniques, intraoperative ultrasound, and enhanced recovery protocols have made segmentectomy increasingly safe with low complication rates and rapid recovery.
Types of Hepatic Segmentectomy
Liver resection encompasses a spectrum of procedures from single segment removal to major hepatectomy, with extent determined by tumour size, location, number, and the patient's liver reserve.
- Single Segmentectomy (removal of one Couinaud segment — minimal resection)
- Bi-Segmentectomy (removal of two adjacent segments)
- Left Lateral Sectionectomy (segments II and III — frequently performed laparoscopically)
- Laparoscopic Segmentectomy (minimally invasive for peripheral and accessible segments)
- Robotic Segmentectomy (robotic-assisted precision in specialised centres)
Risk Factors for Liver Tumours Requiring Segmentectomy
A variety of benign and malignant conditions of the liver may require segmentectomy. Understanding these helps patients appreciate the importance of timely intervention.
- Hepatocellular carcinoma (HCC) in the context of chronic hepatitis B or C and cirrhosis
- Colorectal liver metastases in patients with previous bowel cancer
- Hepatic adenoma in women taking oral contraceptives — risk of rupture
- Gallbladder carcinoma invading the liver requiring combined resection
- Intrahepatic cholangiocarcinoma requiring anatomical resection
- Symptomatic liver cysts or rare benign tumours causing pain or mass effect
Liver Lesion Symptoms
Liver lesions requiring segmentectomy are often discovered incidentally on imaging but can produce specific symptoms when they reach significant size or become complicated.
- Right upper quadrant discomfort or dull aching pain
- Incidental hepatic mass found on abdominal ultrasound or CT scan
- Unexplained weight loss and fatigue suggesting underlying malignancy
- Jaundice if the tumour obstructs intrahepatic bile ducts
- Abdominal distension from a large hepatic tumour or associated ascites
- Sudden severe pain from rupture of a liver adenoma or haematoma
- Elevated liver enzymes or tumour markers (AFP, CEA) on blood testing
- Symptoms of underlying liver disease in patients with HCC
Key Benefits
Discover the advantages of choosing our segmentectomy services.
Removes liver tumours or lesions with clear surgical margins while preserving maximum healthy liver
Precise anatomical technique minimises the amount of healthy liver tissue removed unnecessarily
Laparoscopic approach provides faster recovery with less pain and shorter hospital stay
Intraoperative ultrasound guidance maximises the accuracy and safety of segment boundary division
Appropriate for both primary liver tumours and colorectal metastases with curative intent
Clinical Features
The technology, techniques and clinical approach behind our segmentectomy.
Anatomically defined resection removes the minimum necessary liver volume for oncological safety
Intraoperative ultrasound guides precise segment boundaries for maximum margin accuracy
Laparoscopic segmentectomy available for accessible peripheral segments with faster recovery
Low CVP anaesthetic technique significantly reduces intraoperative blood loss
CUSA technology enables precise parenchymal division with minimal blood loss
Preparation Instructions
- Complete a contrast-enhanced triple-phase CT liver and MRI for precise tumour mapping and volumetric assessment
- Provide blood results including CBC, coagulation, liver function, kidney function, tumour markers, and blood group with crossmatch
- Complete hepatitis B and C serology and viral load testing before surgery
- Optimise nutritional status before surgery — malnutrition significantly increases complication rates
- Stop anticoagulants 5 to 7 days before surgery under haematology supervision
- Fast for 8 to 10 hours before surgery
- Arrange home support for 2 to 3 weeks after discharge
- Pre-operative anaesthetic optimisation is particularly important if underlying liver disease is present
The Procedure
Step-by-step guide to what you can expect during your segmentectomy procedure.
Multi-Disciplinary Liver Team Assessment
Your case is reviewed by the specialist hepatobiliary multi-disciplinary team — including HPB surgeon, hepatologist, oncologist, radiologist, and liver anaesthesiologist — to confirm that hepatic segmentectomy is indicated, technically feasible, and that adequate liver reserve will remain after resection to support normal liver function.
Pre-Operative Volumetric Assessment
CT volumetric analysis quantifies the future liver remnant volume before surgery, ensuring that removing the planned segments will leave adequate functional liver mass. In patients with underlying liver disease, additional assessments of liver function reserve are performed to optimise safety.
Anaesthesia and Low Central Venous Pressure Management
General anaesthesia is administered with a specialised low central venous pressure technique that significantly reduces blood loss during liver parenchymal division. Our hepatobiliary anaesthesiologist maintains continuous precise haemodynamic monitoring throughout.
Intraoperative Ultrasound Mapping
Before any liver tissue is divided, intraoperative ultrasound is used to identify the precise boundaries of the segment to be resected, locate the tumour, confirm margins, and map all portal pedicles and hepatic veins within the planned resection zone — a critical safety step.
Precise Parenchymal Division and Resection
Using advanced energy devices and the Cavitron Ultrasonic Surgical Aspirator (CUSA), your surgeon divides the liver parenchyma along the precisely mapped segment boundaries — preserving all portal pedicles and hepatic veins supplying adjacent healthy segments while resecting the tumour with clear margins.
Haemostasis and Drain Placement
Meticulous haemostasis of the cut liver surface is achieved using bipolar diathermy, argon beam coagulation, and fibrin sealants. A surgical drain is placed alongside the liver resection margin and the abdomen is closed securely. You are transferred to the hepatobiliary surgical HDU for close post-operative monitoring.
What to Expect
Hepatic Segmentectomy is performed under general anaesthesia and takes 2 to 3.5 hours depending on segments resected and the open or laparoscopic approach. The surgeon uses intraoperative ultrasound to precisely demarcate segment boundaries before dividing the liver parenchyma along anatomical planes using specialised energy devices. Most patients are discharged within 5 to 7 days with rapid return to normal activities within 2 to 3 weeks.
Recovery
Attend all scheduled follow-up imaging and blood tests — liver function at 1 week and 1 month, and imaging surveillance for recurrence at intervals recommended by your oncology team. Follow a healthy low-fat diet for 4 to 6 weeks as the liver regenerates and bile production normalises. Abstain completely from alcohol during recovery and maintain lifestyle modifications recommended by your hepatologist. Report any fever, jaundice, right upper quadrant pain, or abdominal distension to your surgical team promptly.
Frequently Asked Questions
Common questions about segmentectomy.
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