World Journal of Surgery

, Volume 43, Issue 5, pp 1303–1307 | Cite as

Intrahepatic Glissonian Approach to the Ventral Aspect of the Arantius Ligament in Laparoscopic Left Hemihepatectomy

  • Ji Hoon Kim
  • Jae-Woon ChoiEmail author
Original Scientific Report with Video



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.

Supplementary material

Supplementary material 1 (WMV 164600 kb)


  1. 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
  2. 2.
    Wakabayashi G, Cherqui D, Geller DA et al (2014) Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd international consensus conference on laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:723–731CrossRefGoogle Scholar
  3. 3.
    Belli G, Gayet B, Han HS et al (2013) Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care. Surg Endosc 27:2721–2726CrossRefGoogle Scholar
  4. 4.
    Cai XJ, Wang YF, Liang YL et al (2009) Laparoscopic left hemihepatectomy: a safety and feasibility study of 19 cases. Surg Endosc 23:2556–2562CrossRefGoogle Scholar
  5. 5.
    Pringle JH (1908) Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 48:541–549CrossRefGoogle Scholar
  6. 6.
    Figueras J, Llado L, Ruiz D et al (2005) Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial. Ann Surg 241:582–590CrossRefGoogle Scholar
  7. 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
  8. 8.
    Takasaki K (1998) Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg 5:286–291CrossRefGoogle Scholar
  9. 9.
    Yamamoto M, Katagiri S, Ariizumi S et al (2012) Glissonean pedicle transection method for liver surgery. J Hepatobiliary Pancreat Sci 19:3–8CrossRefGoogle Scholar
  10. 10.
    Moris D, Rahnemai-Azar AA, Tsilimigras DI et al (2018) Updates and critical insights on Glissonian approach in liver surgery. J Gastrointest Surg 22:154–163CrossRefGoogle Scholar
  11. 11.
    Cho A, Yamamoto H, Kainuma O et al (2012) Arantius’ ligament approach for the left extrahepatic Glissonean pedicle in pure laparoscopic left hemihepatectomy. Asian J Endosc Surg 5:187–190CrossRefGoogle Scholar
  12. 12.
    Rotellar F, Pardo F, Benito A et al (2012) A novel extra-Glissonian approach for totally laparoscopic left hepatectomy. Surg Endosc 26:2617–2622CrossRefGoogle Scholar
  13. 13.
    Chen HW, Deng FW, Hu JY et al (2017) Extra-Glissonian approach for total laparoscopic left hepatectomy: a prospective cohort study. Surg Laparosc Endosc Percutan Tech 27:e145–e148CrossRefGoogle Scholar
  14. 14.
    Machado MA, Surjan RC, Basseres T et al (2016) The laparoscopic Glissonian approach is safe and efficient when compared with standard laparoscopic liver resection: results of an observational study over 7 years. Surgery 160:643–651CrossRefGoogle Scholar
  15. 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
  16. 16.
    Kawaguchi Y, Velayutham V, Fuks D et al (2017) Operative techniques to avoid near misses during laparoscopic hepatectomy. Surgery 161:341–346CrossRefGoogle Scholar
  17. 17.
    Kim JH (2018) Usefulness of the ligamentum venosum as an anatomical landmark for safe laparoscopic left hepatectomy (how I do it). J Gastrointest Surg 22:1464–1469CrossRefGoogle Scholar
  18. 18.
    Takasaki K (2007) Glissonean pedicle transection method for hepatic resection. Springer, Tokyo, pp 62–69Google Scholar
  19. 19.
    Sugioka A, Kato Y, Tanahashi Y (2017) Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: proposal of a novel comprehensive surgical anatomy of the liver. J Hepatobiliary Pancreat Sci 24:17–23CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of SurgeryEulji University School of MedicineDaejeonRepublic of Korea
  2. 2.Department of Surgery, College of Medicine and Medical Research InstituteChungbuk National UniversityCheong-JuRepublic of Korea

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