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It is uncertain whether the general benefits of laparoscopy also extend to RH. This study evaluates perioperative outcomes of laparoscopic vs open RH, and illustrates differences in laparoscopic RH and left hemihepatectomy (LH) within the international, multicentre, double-blinded ORANGE-II-PLUS randomized trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients were randomly assigned to open (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009166) or laparoscopic hemihepatectomy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009166). The present\n                      <jats:italic>post-hoc<\/jats:italic>\n                      subgroup analysis compares perioperative and oncological outcomes of laparoscopic RH (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009105) vs open RH (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009108). In addition, interaction between surgical approach (open or laparoscopic) and hemihepatectomy laterality (RH;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009213 vs LH;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009119) was assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was a higher proportion of malignancy, including more colorectal liver metastases, and more preoperative portal vein embolization in patients undergoing RH compared to LH, other characteristics were well-balanced. The laparoscopic approach was associated with shorter time to functional recovery compared to open surgery for RH (median 5 vs 5\u00a0days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.004) and shorter length of hospital stay (median 5 vs 6\u00a0days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.014). Except for longer operating times in laparoscopy (332 vs 263\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001), no differences were found in other perioperative and oncological outcomes between laparoscopic and open RH. For all outcomes, interaction testing between surgical approach and laterality did not reach significance, suggesting that approach did not affect RH and LH differently. Though patients requiring laparoscopic RH needed longer operating time (332 vs 225\u00a0min) and time to functional recovery (median 5 vs 3\u00a0days) than patients requiring laparoscopic LH.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients undergoing RH showed modest, population-level, benefits from a laparoscopic approach with regard to time to functional recovery and hospital length of stay, despite higher technical complexity and a more pronounced postoperative impact on the patient. Interaction testing between RH and LH did not reach significance, suggesting the effect of the approach on outcomes were consistent regardless of resection laterality. These results support the implementation of the laparoscopic approach for RH if surgeons are experienced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial information<\/jats:title>\n                    <jats:p>NCT01441856.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12588-w","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T19:38:45Z","timestamp":1773085125000},"page":"4195-4205","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic versus open hemihepatectomy: does side matter? 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However, outside of the submitted work Ronald van Dam received grants from Abbott Laboratories and Guerbet for investigator-initiated studies, consulting fees from Fujifilm and receipt of materials from Abbott laboratories. Remon Korenblik received grants from Abbott Laboratories and Guerbet for investigator-initiated studies. Si\u00e2n Pugh reported speakers honoraria from Merck, Takeda and Servier and support for attending meetings and\/or travel from Takeda. Ulf Neumann reported speakers honoraria from Merck, Astra Zenica, Dr. Falk, Amgen, and Roche, and support for attending meetings and\/or travel from Merck and Astra Zenica. Asmund Fretland reported speakers honoraria Olympus, Medtronic, Angiodynamics, and Bayer. The following authors on the manuscript have no conflicts of interest or financial ties to disclose: Bram Olij, Gabriela Pilz da Cunha, Francesca Ratti, Mohammad Abu Hilal, Roberto I. Troisi, Robert P. Sutcliffe, Marc G. Besselink, Somaiah Aroori, Krishna V. Menon, Bj\u00f8rn Edwin, Mathieu D\u2019Hondt, Valerio Lucidi, Tom F. Ulmer, Rafael D\u00edaz-Nieto, Zahir Soonawalla, Steve White, Gregory Sergeant, Christoph Kuemmerli, Vincenzo Scuderi, Frederik Berrevoet, Aude Vanlander, Ravi Marudanayagam, Pieter J. Tanis, Marielle M.E. Coolsen, Robert S. Fichtinger, Zina B. Eminton, Lloyd Brandts, John N. Primrose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}