Abstract
Background
One of the main criticisms of laparoscopic liver resection is that it is difficult, or not possible, to perform liver-sparing resections. Our aim was to present short videos where the intrahepatic Glissonian approach was used to perform anatomical liver segmental resections, instead of a larger operation, to avoid unnecessary sacrifice of the liver parenchyma.
Methods
We selected six types of anatomical liver resections to exemplify the use of the intrahepatic Glissonian approach to perform segment-oriented liver resections. These types of hepatectomies were used as an alternative to right or left hepatectomy, or as an alternative to extended liver resections.
Results
The intrahepatic Glissonian approach was feasible in all cases. The use of anatomical landmarks previously described was essential to reach and control the Glissonian pedicles. Among the liver-sparing resections, we were able to perform right anterior (S5 + S8) and posterior (S6 + S7) sectionectomies, resection of segments 2, 3, and 4, and mesohepatectomy (S4 + S5 + S8). No patient presented postoperative liver failure.
Conclusions
Laparoscopic liver-sparing resections are feasible and may be a good alternative to hemihepatectomies or extended liver resections. The use of the intrahepatic Glissonian approach can be useful.
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REFERENCES
Ciria R, Cherqui D, Geller DA, et al. Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg. 2016;263:761–77.
Brown KM, Geller DA. What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg. 2016;20:1065–71.
Schiffman SC, Kim KH, Tsung A, et al. Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery. 2015;157:211–22.
Machado MA, Makdissi FF, Galvão FH, et al. Intrahepatic Glissonian approach for laparoscopic right segmental liver resections. Am J Surg. 2008;196:e38–e42.
Machado MA, Makdissi FF, Surjan RC, et al. Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach. Surg Endosc. 2009; 23:2615–19.
Launois B, Jamieson GG. The posterior intrahepatic approach for hepatectomy or removal of segments of the liver. Surg Gynecol Obstet. 1992;174:155–58.
Surjan RC, Makdissi FF, Machado MA. Anatomical basis for the intrahepatic Glissonian approach during hepatectomies. Arq Bras Cir Dig. 2015;28:128–31.
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10434_2017_5886_MOESM1_ESM.mp4
This video shows six situations where the intrahepatic Glissonian approach was used to perform laparoscopic parenchymal-sparing liver resections (anatomical hepatectomies) instead of a larger operation such as hemihepatectomy or trisectionectomy. Supplementary material 1 (MP4 132509 kb)
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Machado, M.A.C., Surjan, R., Basseres, T. et al. Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach. Ann Surg Oncol 24, 2353–2354 (2017). https://doi.org/10.1245/s10434-017-5886-3
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DOI: https://doi.org/10.1245/s10434-017-5886-3