Pure laparoscopic living donor hepatectomy using the Glissonean pedicle approach (with video)

  • 333 Accesses

  • 1 Citations



The use of pure laparoscopic donor hepatectomy has been increasing, with various advantages reported. However, the Glissonean approach has not been adopted despite its usefulness. The aim of this study was to introduce the Glissonean pedicle approach for laparoscopic living donor hepatectomy.


We retrospectively reviewed data from 11 patients who underwent pure laparoscopic donor hepatectomy for adult living donor liver transplantation. In this novel operative procedure, after mobilization of the liver, the right or left Glissonean pedicle was encircled, and then the liver parenchymal transection was completed. Next, the right or left hepatic artery, portal vein, and hepatic duct were dissected out. The right or left hepatic duct was divided under intraoperative cholangiography guidance using indocyanine green fluorescence, and the hepatic artery and the portal vein were cut. Finally, the hepatic vein was divided using the laparoscopic stapler, and the graft liver was procured via a suprapubic incision.


The overall median surgical time was 387 min (range 280–563 min), and the volume of blood loss was 75 mL (21–1228 mL). The warm ischemic time was 5 min (2–10 min). A conversion to open procedure was occurred in 1 patient. A complication, a grade IIIa bile leakage according to the Clavien–Dindo classification, was noted in 1 patient.


This is the first report of the Glissonean pedicle approach for pure laparoscopic donor hepatectomy; our results demonstrate the safety and feasibility of this technique.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2


  1. 1.

    Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative Short-term benefits of laparoscopic liver resection: 9000 Cases and Climbing. Ann Surg 263:761–777

  2. 2.

    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Hilal MA, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629

  3. 3.

    Cherqui D (2016) Evolution of laparoscopic liver resection. Br J Surg 103:1405–1407

  4. 4.

    Kaneko H, Otsuka Y, Kubota Y, Wakabayashi G (2017) Evolution and revolution of laparoscopic liver resection in Japan. Ann Gastroenterol Surg 1:33–43

  5. 5.

    Soubrane O, Kwon CH (2017) Tips for pure laparoscopic right hepatectomy in the live donor. J Hepatobiliary Pancreat Sci 24:E1–E5

  6. 6.

    Hasegawa Y, Nitta H, Sasaki A, Takahara T, Itabashi H, Katagiri H, Otsuka K, Nishizuka S, Wakabayashi G (2015) Long-term outcomes of laparoscopic versus open liver resection for liver metastases from colorectal cancer: a comparative analysis of 168 consecutive cases at a single center. Surgery 157:1065–1072

  7. 7.

    Kasai M, Cipriani F, Gayet B, Aldrighetti L, Ratti F, Sarmiento JM, Scatton O, Kim KH, Dagher I, Topal B, Primrose J, Nomi T, Fuks D, Hilal MA (2018) Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery 163:985–995

  8. 8.

    Cheek SM, Sucandy I, Tsung A, Marsh JW, Geller DA (2016) Evidence supporting laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci 23:257–259

  9. 9.

    Brown KM, Geller DA (2016) What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg 20:1065–1071

  10. 10.

    Hasegawa Y, Nitta H, Takahara T, Katagiri H, Kanno S, Otsuka K, Sasaki A (2018) Laparoscopic left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy. Ann Gastroenterol Surg 2:376–382

  11. 11.

    Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D’Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D (2018) The southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg 268:11–18

  12. 12.

    Couinaud C (1999) Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig Surg 16:459–467

  13. 13.

    Takasaki K (1998) Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg 5:286–291

  14. 14.

    Yamamoto M, Ariizumi SI (2018) Glissonean pedicle approach in liver surgery. Ann Gastroenterol Surg 2:124–128

  15. 15.

    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 24:17–23

  16. 16.

    Samstein B, Griesemer A, Halazun K, Kato T, Guarrera JV, Cherqui D, Emond JC (2018) Pure laparoscopic donor hepatectomies: ready for widespread adoption? Ann Surg 268:602–609

  17. 17.

    Soubrane O (2017) Laparoscopic donor hepatectomy: the long and winding road. Transplantation 101:900–901

  18. 18.

    Han HS, Cho JY, Kaneko H, Wakabayashi G, Okajima H, Uemoto S, Soubrane O, Yong CC, Chen CL, Cheung TT, Belli G, Kubo S, Wu YM, Chen KH, Troisi RI, Kwon CHD, Suh KS, Soin AS, Kim KH, Cherqui D (2018) Expert panel statement on laparoscopic living donor hepatectomy. Dig Surg 35:284–288

  19. 19.

    Nitta H, Sasaki A, Fujita T, Itabashi H, Hoshikawa K, Takahara T, Takahashi M, Nishizuka S, Wakabayashi G (2010) Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure. Ann Surg 251:450–453

  20. 20.

    Cherqui D, Soubrane O, Husson E, Barshasz E, Vignaux O, Ghimouz M, Branchereau S, Chardot C, Gauthier F, Fagniez PL, Houssin D (2002) Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 359:392–396

  21. 21.

    Soubrane O, Perdigao Cotta F, Scatton O (2013) Pure laparoscopic right hepatectomy in a living donor. Am J Transplant 13:2467–2471

  22. 22.

    Soubrane O, de Rougemont O, Kim KH, Samstein B, Mamode N, Boillot O, Troisi RI, Scatton O, Cauchy F, Lee SG, Griesemer A, Ahmed Z, Clavien PA, Cherqui D (2015) Laparoscopic living donor left lateral sectionectomy: a new standard practice for donor hepatectomy. Ann Surg 262:757–776

  23. 23.

    Troisi RI, Wojcicki M, Tomassini F, Houtmeyers P, Vanlander A, Berrevoet F, Smeets P, Van Vlierberghe H, Rogiers X (2013) Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: proof of concept. Am J Transplant 13:2472–2478

  24. 24.

    Han HS, Cho JY, Yoon YS, Hwang DW, Kim YK, Shin HK, Lee W (2015) Total laparoscopic living donor right hepatectomy. Surg Endosc 29:184

  25. 25.

    Suh KS, Hong SK, Lee KW, Yi NJ, Kim HS, Ahn SW, Yoon KC, Choi JY, Oh D, Kim H (2018) Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy. Am J Transplant 18:434–443

  26. 26.

    Hong SK, Shin E, Lee KW, Yoon KC, Lee JM, Cho JH, Yi NJ, Suh KS (2018) Pure laparoscopic donor right hepatectomy: perspectives in manipulating a flexible scope. Surg Endosc.

  27. 27.

    Kim KH, Kang SH, Jung DH, Yoon YI, Kim WJ, Shin MH, Lee SG (2017) Initial outcomes of pure laparoscopic living donor right hepatectomy in an experienced adult living donor liver transplant center. Transplantation 101:1106–1110

  28. 28.

    Kwon CHD, Choi GS, Kim JM, Cho CW, Rhu J, Soo Kim G, Sinn DH, Joh JW (2018) Laparoscopic donor hepatectomy for adult living donor liver transplantation recipients. Liver Transpl 24:1545–1553

  29. 29.

    Takahara T, Wakabayashi G, Nitta H, Hasegawa Y, Katagiri H, Umemura A, Takeda D, Makabe K, Otsuka K, Koeda K, Sasaki A (2017) The first comparative study of the perioperative outcomes between pure laparoscopic donor hepatectomy and laparoscopy-assisted donor hepatectomy in a single institution. Transplantation 101:1628–1636

  30. 30.

    Xu J, Hu C, Cao HL, Zhang ML, Ye S, Zheng SS, Wang WL (2016) Meta-analysis of laparoscopic versus open hepatectomy for live liver donors. PLoS ONE 11:e0165319

  31. 31.

    Rotellar F, Pardo F, Benito A, Zozaya G, Marti-Cruchaga P, Hidalgo F, Lopez L, Inarrairaegui M, Sangro B, Herrero I (2017) Totally laparoscopic right hepatectomy for living donor liver transplantation: analysis of a preliminary experience on 5 consecutive cases. Transplantation 101:548–554

  32. 32.

    Sasaki A, Nitta H, Otsuka K, Takahara T, Nishizuka S, Wakabayashi G (2009) Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg 96:274–279

  33. 33.

    Hasegawa Y, Nitta H, Takahara T, Katagiri H, Baba S, Takeda D, Makabe K, Wakabayashi G, Sasaki A (2017) Safely extending the indications of laparoscopic liver resection: when should we start laparoscopic major hepatectomy? Surg Endosc 31:309–316

  34. 34.

    Ikegami T, Shirabe K, Yamashita Y, Yoshizumi T, Harimoto N, Takeishi K, Tsujita E, Itoh S, Maehara Y (2014) Small upper midline incision for living donor hemi-liver graft procurement in adults. J Am Coll Surg 219:e39–e43

  35. 35.

    Kim SH, Kim YK (2012) Living donor right hepatectomy using the hanging maneuver by Glisson’s approach under the upper midline incision. World J Surg 36:401–406

Download references


The authors thank the staff of the Department of Anesthesiology, Iwate Medical University School of Medicine for their assistance.

Author information

Correspondence to Yasushi Hasegawa.

Ethics declarations


Drs. Yasushi Hasegawa, Hiroyuki Nitta, Takeshi Takahara, Hirokatsu Katagiri, Shoji Kanno, and Akira Sasaki have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 409,299 kb)

Supplementary material 2 (MP4 369,677 kb)

Supplementary material 1 (MP4 409,299 kb)

Supplementary material 2 (MP4 369,677 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hasegawa, Y., Nitta, H., Takahara, T. et al. Pure laparoscopic living donor hepatectomy using the Glissonean pedicle approach (with video). Surg Endosc 33, 2704–2709 (2019) doi:10.1007/s00464-019-06818-7

Download citation


  • Donor
  • Glissonean
  • Glissonian
  • Laparoscopy
  • Liver transplantation