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01-05-2018 | How-I-Do-It Article

Transparenchymal glissonean approach: a novel surgical technique for advanced perihilar bile duct cancer

Authors: Hirofumi Kamachi, Toshiya Kamiyama, Yousuke Tsuruga, Tatsuya Orimo, Kenji Wakayama, Shingo Shimada, Tatsuhiko Kakisaka, Hideki Yokoo, Kenichiro Yamashita, Akinobu Taketomi

Published in: Langenbeck's Archives of Surgery | Issue 3/2018

Abstract

Purpose

To increase the surgical opportunities for locally advanced perihilar bile duct cancers that require left-sided hepatectomies, we developed the transparenchymal glissonean approach (TGA); it comprises intra-hepatic exposure and dissection of the Glisson’s sheath to gain access to the hepatic artery and portal vein for reconstruction.

Methods

Following skeletonization of the hepatoduodenal ligament, the proximal portions of invaded vessels are exposed. If extra-hepatic attempts to access the distal portions of the invaded vessels fail, TGA can be used. The distal portion of the invaded right or right posterior Glisson’s sheath is exposed following liver transection. The anterior portion of the wall of bile duct is cut and transected circumferentially including the fibrous plate tissue. The non-invaded portal vein and hepatic artery are isolated and dissected towards the hepatic hilum until the invaded distal portion of the vessels, and vascular reconstructions are performed.

Results

TGA was performed in 9 patients; 5 patients underwent left hemihepatectomy and 4 underwent left tri-sectionectomy. Eight patients needed vascular reconstruction. Clavien-Dindo classification (CDC) grades IIIa and IIIb were recorded in 6 and 1 patients, respectively. No patients had CDC grades IV and V disease. Pathologically, all cases were pT4; 3 cases were R0, 5 were R1 with microscopic positive margin, and 2 were R1 with microscopic metastasis. The overall median survival time was 25.0 months.

Conclusions

TGA is feasible with acceptable prognosis and expands the surgical opportunities.

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Title: Transparenchymal glissonean approach: a novel surgical technique for advanced perihilar bile duct cancer
Authors: Hirofumi Kamachi
Toshiya Kamiyama
Yousuke Tsuruga
Tatsuya Orimo
Kenji Wakayama
Shingo Shimada
Tatsuhiko Kakisaka
Hideki Yokoo
Kenichiro Yamashita
Akinobu Taketomi
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 3/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1633-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transparenchymal glissonean approach: a novel surgical technique for advanced perihilar bile duct cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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