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Standardization of laparoscopic anatomic liver resection of segment 2 by the Glissonean approach

  • 2022 EAES Oral Dynamic
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Anatomic liver resection (ALR) has been established to eliminate the tumor-bearing hepatic region with preservation of the remnant liver volume for liver malignancies. Recently, laparoscopic ALR has been widely applied; however, there are few reports on laparoscopic segmentectomy 2. This study aimed to present the standardization of laparoscopic segmentectomy 2 with surgical outcomes.

Methods

This study included seven patients who underwent pure laparoscopic segmentectomy 2 by the Glissonean approach from January 2020 to December 2021. Four of them had hepatocellular carcinoma, two had colorectal liver metastasis, and one had hepatic angiomyolipoma, which was preoperatively diagnosed with hepatocellular carcinoma. In all patients, preoperative three-dimensional (3D) simulation images from dynamic CT were reconstructed using a 3D workstation. The layer between the hepatic parenchyma and the Glissonean pedicle of segment 2 (G2) was dissected to encircle the root of G2. After clamping or ligation of the G2, 2.5 mg of indocyanine green was injected intravenously to identify the boundaries between segments 2 and 3 with a negative staining method under near-infrared light. Parenchymal transection was performed from the caudal side to the cranial side according to the demarcation on the liver surface, and the left hepatic vein was exposed on the cut surface if possible.

Results

The mean operative time for all patients was 281 min. The mean blood loss was 37 mL, and no transfusion was necessary. Estimated liver resection volumes significantly correlated with actual liver resection volumes (r = 0.61, P = 0.035). After the operation, one patient presented with asymptomatic deep venous and pulmonary thrombosis, which was treated with anticoagulant therapy. The mean length of hospital stay was 8.9 days.

Conclusion

Laparoscopic segmentectomy 2 by the Glissonean approach is a feasible and safe procedure with the preservation of the nontumor-bearing segment 3 for liver tumors in segment 2.

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Acknowledgements

The authors would like to thank Dr. Ryosuke Fujinaka for his assistance in recording the voiceover for the Supplementary videos.

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Authors and Affiliations

  1. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Takeshi Urade, Masahiro Kido, Kaori Kuramitsu, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Shinichi So, Takuya Mizumoto, Yoshihide Nanno, Daisuke Tsugawa, Tadahiro Goto, Sadaki Asari, Hiroaki Yanagimoto, Hirochika Toyama, Tetsuo Ajiki & Takumi Fukumoto

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  1. Takeshi Urade
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Correspondence to Takeshi Urade.

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Disclosures

Takeshi Urade, Masahiro Kido, Kaori Kuramitsu, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Shinichi So, Takuya Mizumoto, Yoshihide Nanno, Daisuke Tsugawa, Tadahiro Goto, Sadaki Asari, Hiroaki Yanagimoto, Hirochika Toyama, Tetsuo Ajiki, and Takumi Fukumoto have no conflicts of interest or financial ties to disclose.

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Urade, T., Kido, M., Kuramitsu, K. et al. Standardization of laparoscopic anatomic liver resection of segment 2 by the Glissonean approach. Surg Endosc 36, 8600–8606 (2022). https://doi.org/10.1007/s00464-022-09613-z

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