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Laparoscopic right posterior anatomic liver resections with Glissonean pedicle-first and venous craniocaudal approach

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Abstract

Background

Laparoscopic segment 7 segmentectomy and segment 6–7 bisegmentectomy are challenging resections because of the posterior position and the lack of landmarks. The anatomy of the right posterior Glissonean pedicle and the caudal view of laparoscopy make such resections suitable for the Glissonean pedicle-first approach.

Methods

The study population included all consecutive patients treated with laparoscopic liver resection from August 2019 to February 2020. The approach is based on the ultrasonographic identification of the right posterior or segmental pedicle from the dorsal side of the liver after complete mobilization. The pedicle of interest is isolated through mini-hepatotomy and clamped. The segment anatomy is defined by ischemia. The transection starts from the ventral side, close to the right hepatic vein that is exposed and followed craniocaudally.

Results

Ten patients underwent anatomical laparoscopic resection of right posterolateral segments. There were 7 colorectal liver metastases, 2 hepatocellular carcinoma, and 1 biliary cysto-adenoma. Five patients underwent Sg7 resection, one patient underwent a Sg7 subsegmentectomy, and 4 underwent Sg6-7 bisegmentectomy. The Glissonean pedicle-first approach was feasible in eight patients. The craniocaudal approach to the RHV was feasible in six patients, not indicated in three cases and was abandoned in one patient for technical difficulty. There was no operative morbidity or mortality. Median post-operative hospital stay was 5 days.

Conclusions

The Glissonean pedicle-first approach is safe and effective for laparoscopic anatomic resections of the right posterior sector. The craniocaudal approach to right hepatic vein from the ventral side is a convenient procedure to follow the segmental anatomy deep in the parenchyma.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General and Oncological Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati 62, 10128, Turin, Italy

    Alessandro Ferrero, Roberto Lo Tesoriere, Francesco Giovanardi, Serena Langella, Fabio Forchino & Nadia Russolillo

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  1. Alessandro Ferrero
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  2. Roberto Lo Tesoriere
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  3. Francesco Giovanardi
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  4. Serena Langella
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  5. Fabio Forchino
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  6. Nadia Russolillo
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Corresponding author

Correspondence to Roberto Lo Tesoriere.

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Disclosures

Drs. A. Ferrero, R. Lo Tesoriere, F. Giovanardi, S. Langella, F. Forchino, and N. Russolillo have no conflicts of interest or financial ties to disclose concerning the funding of this study.

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Ferrero, A., Lo Tesoriere, R., Giovanardi, F. et al. Laparoscopic right posterior anatomic liver resections with Glissonean pedicle-first and venous craniocaudal approach. Surg Endosc 35, 449–455 (2021). https://doi.org/10.1007/s00464-020-07916-7

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  • DOI: https://doi.org/10.1007/s00464-020-07916-7

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