Pure Laparoscopic Anatomic Resection of the Segment 8 Ventral Area Using the Transfissural Glissonean Approach

Abstract

Background

Pure laparoscopic anatomic resection of liver segment 8 still is rarely performed due to technical difficulties and the anatomic complexity.1^,2 Limited resection of the segment 8 ventral area has been possible because the right anterior section can be divided into ventral and dorsal areas.3^,4 This report describes the technique of pure laparoscopic anatomic resection of the segment 8 ventral area using the transfissural Glissonean approach.

Methods

A 43-year-old woman who had been taking oral contraceptives for 3 years was referred for treatment of a single nodular tumor located in the segment 8 ventral area. The surgical procedure involved the following steps: (1) dissection and clamping of the right Glissonean pedicle, (2) identification of the main portal fissure, (3) parenchymal dissection along the main portal fissure,5,6,7,^–8 (4) dissection and ligation of the segment 8 ventral portal pedicle, and (5) transection of the ischemic demarcation line of the segment 8 ventral area.

Results

The operative time was 180 min, and the estimated blood loss was 30 mL. The total Pringle maneuver time was 45 min. The final histopathologic diagnosis was an adenoma. The tumor size was 6 mm, and the resection margin was negative. The patient had an uneventful postoperative recovery, and she was discharged on postoperative day 3.

Conclusion

The transfissural Glissonean approach for laparoscopic anatomic resection of the segment 8 ventral area is a feasible and effective technique. Opening of the main portal fissure allows easy and direct access to the segment 8 ventral branch.