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Pure laparoscopic anatomical segment VI resection using the Glissonian approach, Rouviere’s sulcus as a landmark, and a modified liver hanging maneuver (with video)

Langenbeck's Archives of Surgery volume 403, pages 131–135 (2018)Cite this article

Abstract

Background

Pure laparoscopic anatomical segmental resection has rarely been reported because this technique frequently presents technical difficulties. We describe the laparoscopic resection of anatomical segment VI using the Glissonian approach and a modified liver hanging maneuver.

Methods

Rouviere’s sulcus is identified after retracting superiorly the gallbladder. The Glissonian approach for anatomical resection of segment VI can be performed with minimal dissection of the liver parenchyma around the sulcus. After clamping the Glissonian pedicle in the sulcus, the ischemic area fed by the portal pedicle was confirmed. The right triangular ligament was divided to create a small opening for placement of the hanging tape along the ischemic line. The liver parenchymal transection was performed along the hanging tape.

Results

Four patients underwent pure laparoscopic anatomical segment VI resection using the Glissonian approach and a modified liver hanging maneuver. The median operation time was 205 min (range, 110–250 min), and median estimated blood loss was 110 mL (range, 100–350 mL). The median postoperative hospital stay was 5 days (range, 4–8 days). There was no postoperative morbidity or mortality.

Conclusion

The Glissonian approach at Rouviere’s sulcus as a landmark combined with the modified liver hanging maneuver may be safe and useful for laparoscopic anatomical segment VI resection.

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Affiliations

  1. Department of Surgery, College of Medicine, Eulji University, Daejeon, Republic of Korea

    Ji Hoon Kim, Byung Sun Cho & Je-Ho Jang

Authors
  1. Ji Hoon Kim
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  2. Byung Sun Cho
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  3. Je-Ho Jang
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Contributions

Study conception and design: Ji Hoon Kim. Acquisition of data: Ji Hoon Kim, Je-Ho Jang. Analysis and interpretation of data: Ji Hoon Kim. Drafting of the manuscript: Ji Hoon Kim. Critical revision of the manuscript: Ji Hoon Kim, Byung Sun Cho

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Correspondence to Ji Hoon Kim.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Kim, J.H., Cho, B.S. & Jang, JH. Pure laparoscopic anatomical segment VI resection using the Glissonian approach, Rouviere’s sulcus as a landmark, and a modified liver hanging maneuver (with video). Langenbecks Arch Surg 403, 131–135 (2018). https://doi.org/10.1007/s00423-018-1652-7

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  • DOI: https://doi.org/10.1007/s00423-018-1652-7

Keywords

  • Laparoscopic liver resection
  • Glissonian approach
  • Liver hanging maneuver
  • Rouviere’s sulcus