Top

Published in:

01-06-2019 | Liver Resection | Multimedia Article

Pure Laparoscopic Anatomical Resection of the Ventral Area of the Right Anterior Section Using the Transfissural Glissonean Approach

Author: Ji Hoon Kim

Published in: Journal of Gastrointestinal Surgery | Issue 6/2019

Abstract

The introduction of the anatomical concept of classifying the right anterior section (RAS) into the ventral and dorsal areas enabled the development of limited resection of the ventral or dorsal area. Anatomical resection of the ventral area of the RAS is technically demanding because it requires determination of the boundary of the ventral area and two large of transection planes. We present a technique for laparoscopic anatomical resection of the ventral area of the RAS using a transfissural Glissonean approach.

In the transfissural Glissonean approach, the portal or umbilical fissure is opened after liver parenchymal dissection, and then, the surgeon can confirm the Glissonean pedicles and territory. The procedure was as follows: (1) dissection of the right anterior portal pedicle (RAPP) for the identification of the main portal fissure, (2) opening of the main portal fissure, (3) dissection and clamping of the ventral branch of the RAPP, and (4) transection of the borderline of the ventral and dorsal areas.

The transfissural Glissonean approach is a feasible and effective technique for laparoscopic anatomical resection of the ventral area of the RAS. Opening the main portal fissure allows easy and direct access to the ventral branch of the RAPP.

Available only for authorised users

Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, OʼRourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 2015;261:619–629.

Kim YK, Han HS, Yoon YS, Cho JY, Lee W. Total anatomical laparoscopic liver resection of segment 4 (s4), extended s4, and subsegments s4a and s4b for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 2015;25:375–379.CrossRefPubMed

Ishizawa T, Gumbs AA, Kokudo N, Gayet B. Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 2012;256:959–64.CrossRefPubMed

Kim JH, Cho BS, Jang JH. Pure laparoscopic anatomical segment VI resection using the Glissonian approach, Rouviere's sulcus as a landmark, and a modified liver hanging maneuver (with video). Langenbecks Arch Surg 2018;403:131–135.CrossRefPubMed

Kogure K, Kuwano H, Fujimaki N, Ishikawa H, Takada K. Reproposal for Hjortsjo’s segmental anatomy on the anterior segment in human liver. Arch Surg 2002;137:1118–1124.CrossRefPubMed

Cho A, Okazumi S, Makino H, Miura F, Shuto K, Mochiduki R, Tohma T, Kudo H, Matsubara K, Gunji H, Yamamoto H, Ryu M, Ochiai T. Anterior fissure of the right liver—the third door of the liver. J Hepatobiliary Pancreat Surg 2004;11:390–396.CrossRefPubMed

Fujimoto J, Hai S, Hirano T, Iimuro Y, Yamanaka J. Anatomic liver resection of right paramedian sector: ventral and dorsal resection. J Hepatobiliary Pancreat Sci 2015;22:538–535.CrossRefPubMed

Kurimoto A, Yamanaka J, Hai S, Kondo Y, Sueoka H, Ohashi K, Asano Y, Hirano T, Fujimoto J. Parenchyma-preserving hepatectomy based on portal ramification and perfusion of the right anterior section: preserving the ventral or dorsal area. J Hepatobiliary Pancreat Sci 2016;23:158–166.CrossRefPubMed

Machado MA, Surjan RC, Basseres T, Schadde E, Costa FP, Makdissi FF. The laparoscopic Glissonian approach is safe and efficient when compared with standard laparoscopic liver resection: Results of an observational study over 7 years. Surgery 2016;160:643–651.CrossRefPubMed

10.

Takasaki K. Glissonean pedicle transection method for hepatic resection: A new concept of liver segmentation. J Hepatobiliary Pancreat Surg 1998;5: 286–291.CrossRefPubMed

11.

Yamamoto M, Katagiri S, Ariizumi S, Kotera Y, Takahashi Y, Egawa H. Tips for anatomical hepatectomy for hepatocellular carcinoma by the Glissonean Pedicle approach (with videos). J Hepatobiliary Pancreat Sci 2014;21:E53–56.

12.

Couinaud C. Surgical anatomy of the liver revisited. Paris, France: Selfprinted; 1989.

13.

Wang HJ. Anatomical liver resection: Glissonean approach. Koonja, 2015; pp. 67–85. (in Korean)

14.

Xu W, Wang HJ, Kim BW, Park YK, Li G. Anatomical Variation of the Glissonean Pedicle of the Right Liver. Korean J Hepatobiliary Pancreat Surg 2011;15:101–106.CrossRefPubMedPubMedCentral

Title: Pure Laparoscopic Anatomical Resection of the Ventral Area of the Right Anterior Section Using the Transfissural Glissonean Approach
Author: Ji Hoon Kim
Publication date: 01-06-2019
Publisher: Springer US
Keywords: Liver Resection
Liver Resection
Published in: Journal of Gastrointestinal Surgery / Issue 6/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04177-1

At a glance: The STEP trials

Springer Medicine

Pure Laparoscopic Anatomical Resection of the Ventral Area of the Right Anterior Section Using the Transfissural Glissonean Approach

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2019

Endoscopic Submucosal Dissection for Esophageal Adenocarcinoma: A North American Perspective

Use of Activity Tracking in Major Visceral Surgery—the Enhanced Perioperative Mobilization Trial: a Randomized Controlled Trial

Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis

Outcome of Surgical Inspection of the Gallbladder in Relation to Final Pathology

The 5-HT4 Receptor Agonist Prucalopride Stimulates Mucosal Growth and Enhances Carbohydrate Absorption in the Ileum of the Mouse

Rates of Serious Complications Estimated by the ACS-NSQIP Surgical Risk Calculator in Predicting Oncologic Outcomes of Patients Treated with Pancreaticoduodenectomy for Pancreatic Head Cancer