Abstract
Background
Hemorrhage from portal and hepatic veins is a major concern with laparoscopic right hepatectomy (LRH). The standard hilar approach is dissection of the portal pedicle outside the liver parenchyma with separate transection of the right hepatic artery, portal vein, and bile duct [1–5, 7, 9]. Variations in anatomy can hamper vascular and biliary control. The intrahepatic Glissonian access avoids these risks by en masse ligation of the portal structures without dissection for each separately [6, 8]. This technique was performed laparoscopically for the last 2 among 10 LRHs, and the results are presented.
Methods
Total LRH was performed under ultrasound assistance for two patients with malignancy. After lymph node sampling at the hepatoduodenal ligament, dissection was started with the incision of liver parenchyma posterior and anterior to the hilum, then continued outside the portal pedicle bifurcation toward the right and left sheaths. An endoscopic vascular stapling device was placed to transect the right portal pedicle en masse under direct laparoscopic vision and cholangiography guidance. Parenchymal transection and vascular control of the right hepatic vein was accomplished with harmonic scalpel, cavitron ultrasonic aspirator, bipolar diathermy, clips, and endoscopic stapling device, as appropriate. No Pringle’s maneuver was used. The specimen was extracted through a suprapubic incision using an endobag.
Results
The operative times for the two patients were, respectively, 180 and 240 min. No blood loss occurred during the intrahepatic Glissonian dissection. Intraoperative blood loss (from the right hepatic vein) of 700 and 800 ml, respectively, was controlled laparoscopically. The postoperative periods were uneventful, with discharge, respectively, on days 6 and 7. The surgical resection margins were free of tumor.
Conclusions
The laparoscopic intrahepatic Glissonian approach used for right hepatectomy is safe, simple, and reproducible. It facilitates the hepatic hilar dissection with minimal operative risk. Further implementation of this technique is encouraged to improve the outcome for patients undergoing laparoscopic liver resection.
Similar content being viewed by others
References
Cherqui D (2003) Laparoscopic liver resection. Br J Surg 90: 644–646
Dulucq JL, Wintringer P, Stabilini C, Mahajna A (2005) Laparoscopic liver resections: a single center experience. Surg Endosc 19: 886–891
Gagner M, Rogula T, Selzer D (2004) Laparoscopic liver resection: benefits and controversies. Surg Clin North Am 84: 451–462
Gigot JF, Glineur D, Azagra JS, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236: 90–97
Hompes D, Aerts R, Penninckx F, Topal B (2007) Laparoscopic liver resection using radiofrequency coagulation. Surg Endosc 21: 175–180
Machado MA, Herman P, Figueira ER, Bacchella T, Machado MC (2006) Intrahepatic Glissonian access for segmental liver resection in cirrhotic patients. Am J Surg 192: 388–392
O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8: 213–216
Ton That Tung (1979) Les resections majeures et mineures du foie. Paris, Masson
Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93: 67–72
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Supplementary material
Rights and permissions
About this article
Cite this article
Topal, B., Aerts, R. & Penninckx, F. Laparoscopic intrahepatic Glissonian approach for right hepatectomy is safe, simple, and reproducible. Surg Endosc 21, 2111 (2007). https://doi.org/10.1007/s00464-007-9303-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9303-z