The Extrahepatic Glissonian Versus Hilar Dissection Approach for Laparoscopic Formal Right and Left Hepatectomies in Patients with Hepatocellular Carcinoma

  • Fei Liu
  • YongGang WeiEmail author
  • Kefei Chen
  • HongYu Li
  • Wentao Wang
  • Hong Wu
  • Tianfu Wen
  • Bo LiEmail author
Original Article



Few studies have been performed to evaluate the value of the Glissonian approach (GA) for laparoscopic formal hemihepatectomy. The purpose of this study was to compare the outcomes of extrahepatic GA with those of the conventional hilar dissection approach for laparoscopic formal right and left hepatectomies in patients with hepatocellular carcinoma (HCC).


Between January 2015 and October 2017, a total of 95 HCC patients who underwent pure laparoscopic formal hemihepatectomies, of whom 49 underwent the GA, were included in this study. After a 1:1 propensity score matching, 42 laparoscopic GA hepatectomies were compared to 42 conventional approach (CA) hepatectomies. We have analyzed perioperative and oncologic outcomes of the two different operative approaches for HCC treatments.


The GA did not increase the postoperative overall complication rates (P = 0.415) or the mean comprehensive complication index (P = 0.414) when compared with the CA. However, the operative time was significantly shorter (P = 0.006), and intraoperative blood loss was significantly lower (P < 0.001) in the GA group than in the CA group. There were no significant differences between the GA and CA groups regarding 3-year overall survival rate (P = 0.765) or 3-year disease-free survival rate (P = 0.622).


Pure laparoscopic extrahepatic GA hemihepatectomy is safe and feasible, and it was associated with similar complication rates and equivalent 3-year survival outcomes compared to the conventional approach in selected patients with HCC.


Laparoscopic hepatectomy Extrahepatic Glissonian approach Hilar dissection approach Hepatocellular carcinoma 



We thank LetPub ( for its linguistic assistance during the preparation of this manuscript.

Author Contribution

Fei Liu: designed research/study, performed research/study, collected data, analyzed data, wrote the paper, and edited the manuscript. Yonggang Wei and Kefei Chen: performed research/study, collected data, analyzed data, and reviewed/edited the manuscript. Hongyu Li: collected data, analyzed data, and reviewed/edited the manuscript. Wentao Wang and Hong Wu: designed research/study, acquired data, and reviewed the manuscript. Tianfu Wen and Bo Li: designed research/study, performed research/study, reviewed the manuscript, and revised the manuscript.

Funding Information

This work was supported by the National Natural Science Foundation of China (No. 81602910) and the Fundamental Research Fund for the Central Universities (No. 2017SCU11045).

Compliance with Ethical Standards

The study was approved by the Ethics Committee of West China Hospital of Sichuan University.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4135_Fig4_ESM.png (1.3 mb)
Figure S1

The right Glissonian pedicle was transected by a linear stapler while the tape was retracted toward the left side. (PNG 1314 kb)

11605_2019_4135_MOESM1_ESM.tif (1.3 mb)
High resolution image (TIF 1348 kb)
11605_2019_4135_MOESM2_ESM.doc (38 kb)
Table S1 (DOC 38 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Liver Surgery&Liver Transplantation Center, West China HospitalSichuan UniversityChengduChina
  2. 2.Department of Pancreatic Surgery, West China HospitalSichuan UniversityChengduChina

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