Abstract
Background
Anatomical segmentectomy is a technically difficult procedure owing to the complexity of the segmental anatomy of the liver. In the conventional Glissonean approach from the liver hilum, the tertiary portal pedicles may be difficult to dissect because of their anatomical variations and deep location. We present a technique of purely laparoscopic anatomical segmentectomy of the liver using the transfissural Glissonean approach.
Methods
We performed purely laparoscopic anatomical segmentectomy using the transfissural Glissonean approach. This approach involved initially opening the liver parenchyma along the fissure line (main portal, right portal, and umbilical fissures). Thereafter, the target tertiary portal pedicles were approached and ligated within the liver parenchyma above the liver hilum.
Results
Between August 2014 and September 2019, we performed 17 cases of laparoscopic anatomical segmentectomy using the transfissural Glissonean approach. The median operative time was 200 min (range 120–310 min), and the intraoperative blood loss was 80 mL (range 30–280 mL). The median postoperative hospital stay was 6 days (range 3–9 days). There was no major morbidity or mortality.
Conclusion
The transfissural Glissonean approach in laparoscopic anatomical segmentectomy is technically feasible because opening the fissure allows direct access to the tertiary portal pedicles.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- MPF:
-
Main portal fissure
- UF:
-
Umbilical fissure
- RAS:
-
Right anterior section.
- RPF:
-
Right portal fissure.
- RPS:
-
Right posterior section.
References
Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350
Ahn KS, Kang KJ, Park TJ, Kim YH, Lim TJ, Kwon JH (2013) Benefit of systematic segmentectomy of the hepatocellular carcinoma: revisiting the dye injection method for various portal vein branches. Ann Surg 258:1014–1021
Jang JY, Han HS, Yoon YS, Cho JY, Choi YR, Lee W, Shin HK, Choi HL (2017) Three-dimensional laparoscopic anatomical segment 8 liver resection with Glissonian approach. Ann Surg Oncol 24:1606–1609
Berardi G, Wakabayashi G, Igarashi K et al (2019) Full laparoscopic anatomical segment 8 resection for hepatocellular carcinoma using the Glissonian approach with indocyanine green dye fluorescence. Ann Surg Oncol 6:2577–2578
Okuda Y, Honda G, Kobayashi S, Sakamoto K, Homma Y, Honjo M, Doi M (2018) Intrahepatic glissonean pedicle approach to segment 7 from the dorsal side during laparoscopic anatomic hepatectomy of the cranial part of the right liver. J Am Coll Surg 226:e1–e6
Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964
Takasaki K (1998) Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepato-Biliary-Pancreat Surg 5:286–291
Yamamoto M, Katagiri S, Ariizumi S, Kotera Y, Takahashi Y, Egawa H (2014) Tips for anatomical hepatectomy for hepatocellular carcinoma by the Glissonean pedicle approach (with videos). J Hepatobiliary Pancreat Sci 21:E53–E56
Couinaud C Surgical anatomy of the liver revisited. Paris, France: Selfprinted; 1989
Wang HJ (2015) Anatomical liver resection: Glissonean approach. Koonja, (in Korean)
Honda G, Kurata M, Tsuruta K (2008) Approach for systematic resection of the liver antero-superior area: exposing Glissonean pedicles by prior dissection of the major hepatic fissure. J Am Coll Surg 207:e1–e4
Kim JH, Kim H (2019) Pure laparoscopic anatomical segment V resection using the extrafascial and transfissural Glissonean approach. Ann Surg Oncol 26:2241
Kim JH (2019) Pure laparoscopic anatomical resection of the ventral area of the right anterior section using the transfissural Glissonean approach. J Gastrointest Surg 23:1279–1282
Kim JH, Kim H (2019) Pure laparoscopic anatomic resection of the segment 8 ventral area using the transfissural Glissonean approach. Ann Surg Oncol 26:4608–4609
Kim JH (2019) Pure laparoscopic anatomical resection of the segment 8 dorsal area using the transparenchymal Glissonean approach (video). Surg Oncol 31:99–100
Calise F, Giuliani A, Sodano L, Crolla E, Bianco P, Rocca A, Ceriello A (2015) Segmentectomy: is minimally invasive surgery going to change a liver dogma? Updat Surg 67:111–115
Kogure K, Kuwano H, Fujimaki N et al (2002) Reproposal for Hjortsjo’s segmental anatomy on the anterior segment in human liver. Arch Surg 137:1118–1124
Araki K, Conrad C, Ogiso S, Kuwano H, Gayet B (2014) Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 218:e37–e41
Nakayama K, Oshiro Y, Miyamoto R, Kohno K, Fukunaga K, Ohkohchi N (2017) The effect of three- dimensional preoperative simulation on liver surgery. World J Surg 41:1840–1847
Aoki T, Koizumi T, Mansour DA et al (2019) Ultrasound-guided preoperative positive percutaneous indocyanine green fluorescence staining for laparoscopic anatomical liver resection. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2019.11.004
Berardi G, Igarashi K, Li CJ et al (2019) Parenchymal sparing anatomical liver resections with full laparoscopic approach: description of technique and short-term results. Ann Surg doi: https://doi.org/10.1097/SLA.0000000000003575
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
Yamamoto M, Ariizumi SI (2018) Glissonean pedicle approach in liver surgery. Ann Gastroenterol Surg 2:124–128
Kim JH, Cho BS, Jang JH (2018) 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 Arch Surg 403:131–135
Author information
Authors and Affiliations
Contributions
Study conception and design: Ji Hoon Kim. Acquisition of data: Ji Hoon Kim. Analysis and interpretation of data: Ji Hoon Kim, Drafting of manuscript: Ji Hoon Kim. Critical revision of manuscript: Ji Hoon Kim.
Corresponding author
Ethics declarations
Conflict of interest
The author declare that they have no conflict 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
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kim, J.H. Laparoscopic anatomical segmentectomy using the transfissural Glissonean approach. Langenbecks Arch Surg 405, 365–372 (2020). https://doi.org/10.1007/s00423-020-01889-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-020-01889-w