Published in:
01-05-2020 | Liver Resection | How-I-Do-It articles
Laparoscopic anatomical segmentectomy using the transfissural Glissonean approach
Published in: Langenbeck's Archives of Surgery | Issue 3/2020
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Background
Anatomical segmentectomy is a technically difficult procedure owing to the complexity of the segmental anatomy of the liver. In the conventional Glissonean approach from the liver hilum, the tertiary portal pedicles may be difficult to dissect because of their anatomical variations and deep location. We present a technique of purely laparoscopic anatomical segmentectomy of the liver using the transfissural Glissonean approach.
Methods
We performed purely laparoscopic anatomical segmentectomy using the transfissural Glissonean approach. This approach involved initially opening the liver parenchyma along the fissure line (main portal, right portal, and umbilical fissures). Thereafter, the target tertiary portal pedicles were approached and ligated within the liver parenchyma above the liver hilum.
Results
Between August 2014 and September 2019, we performed 17 cases of laparoscopic anatomical segmentectomy using the transfissural Glissonean approach. The median operative time was 200 min (range 120–310 min), and the intraoperative blood loss was 80 mL (range 30–280 mL). The median postoperative hospital stay was 6 days (range 3–9 days). There was no major morbidity or mortality.
Conclusion
The transfissural Glissonean approach in laparoscopic anatomical segmentectomy is technically feasible because opening the fissure allows direct access to the tertiary portal pedicles.