Intrahepatic Glissonian Approach to the Ventral Aspect of the Arantius Ligament in Laparoscopic Left Hemihepatectomy
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Laparoscopic left hemihepatectomy using the Glissonian approach is technically challenging secondary to a thick Glissonian pedicle and limited maneuverability of laparoscopic instruments. This procedure demands extreme caution owing to the high risk of bile leakage associated with left hemihepatectomy. We describe the technical details and surgical outcomes of the intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament in laparoscopic left hemihepatectomy.
After detachment of the left side of hilar plate, the meticulous dissection was performed in the liver capsule above the left Glissonian pedicle. Dissection of the ventral aspect of the Arantius ligament creates the space between the liver parenchyma and the left Glissonian pedicle. The left Glissonian pedicle was isolated and encircled using the long curved laparoscopic instrument. During the parenchymal transection, the left Glissonian pedicle was transected using lateral to the Arantius ligament.
Between February 2013 and July 2018, 13 consecutive patients underwent pure laparoscopic left hemihepatectomy. The median operation time was 230 min (range 180–300 min), and the median estimated blood loss was 300 mL (range 100–600 mL). Two patients (15%) required transfusion. The median tumor size was 40 mm (range 10–105 mm). All patients showed negative resection margins. The median postoperative hospital stay was 8 days (range 6–15 days). Major postoperative complications occurred in 1 patient (7.7%). No perioperative deaths occurred.
An intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament is a feasible and effective technique in laparoscopic left hemihepatectomy.
Compliance with ethical standards
Conflict of interest
All the authors declare that they have no conflict of interests.
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- 1.Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629Google Scholar
- 7.Figueras J, Lopez-Ben S, Llado L et al (2003) Hilar dissection versus the “Glissonean” approach and stapling of the pedicle for major hepatectomies: a prospective, randomized trial. Ann Surg 238:111–119Google Scholar
- 15.LoCM Fan ST, Liu CL et al (1998) Biliary complication after hepatic resection: risk factors, management, and outcome. Arch Surg 133:156–161Google Scholar
- 18.Takasaki K (2007) Glissonean pedicle transection method for hepatic resection. Springer, Tokyo, pp 62–69Google Scholar