Abstract
Background
Laparoscopic right posterior sectionectomy is technically challenging secondary to poor exposure of the surgical field and difficulty with controlling hemorrhage during deeper parenchymal transection Cho et al., Surgery 158:135–141, 2015; Lee et al., Surgery 160:1219–1226, 2016. We present laparoscopic right posterior sectionectomy using the Glissonean approach and a modified liver hanging maneuver.
Methods
A 57-year-old man presented with a single mass in segment 7 of the liver. He was placed in the lithotomy position, and five trocars were used in the upper abdomen. The hepatoduodenal ligament was encircled using an umbilical tape to perform the intermittent Pringle maneuver.
After detachment of the hilar plate, the right posterior Glissonean pedicle was dissected and clamped to confirm ischemic delineation Takasaki, J Hepato-Biliary-Pancreat Surg 5:286–291, 1998. After complete mobilization of the right liver, the hanging tape was placed along the inferior vena cava between the caval ligament and the right hepatic vein. The hanging tape elevates the liver and guides the surgeon to achieve an accurate transection plane
Belghiti et al., J Am Coll Surg 193:109–111, 2001; Kim et al., Surg Endosc 30:3611–3617, 2016; Kim, Choi, J Gastrointest Surg 21:1181–1185, 2017; Kim et al., Langenbecks Arch Surg 403:131–135, 2018 . The transection plane used during a right posterior sectionectomy is horizontal and follows the inferior vena cava. However, with the liver hanging maneuver, the horizontal transection plane becomes vertical.
Result
The operation time was 290 min, the estimated blood loss was 120 mL, and the total Pringle maneuver time was 60 min. Final histopathological diagnosis showed a 1.7-cm-sized hepatocellular carcinoma with the resection margin measuring 1.5 cm. The patient was discharged on postoperative day 7 without any complications.
Conclusion
A Glissonean approach with a modified liver hanging maneuver is feasible and useful for laparoscopic right posterior sectionectomy.
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References
Cho JY, Han HS, Yoon YS, Choi Y, Lee W. Outcomes of laparoscopic right posterior sectionectomy in patients with hepatocellular carcinoma in the era of laparoscopic surgery. Surgery 2015;158:135–141
Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK, Jang JY, Choi H, Jang JS, Kwon SU. Comparison of laparoscopic liver resection for hepatocellular carcinoma located in the posterosuperior segments or anterolateral segments: A case-matched analysis. Surgery 2016;160:1219–1226
Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepato-Biliary-Pancreat Surg 1998;5:286–291
Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 2001;193:109–111
Kim JH, Ryu DH, Jang LC, Choi JW. Lateral approach liver hanging maneuver in laparoscopic anatomical liver resections. Surg Endosc 2016;30:3611–3617
Kim JH, Choi JW. A modified liver hanging maneuver in pure laparoscopic left hemihepatectomy with preservation of the middle hepatic vein: video and technique. J Gastrointest Surg 2017;21:1181–1185
Kim JH, Cho BS, 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 2018;403:131–135
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Ji Hoon Kim was involved with study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision.
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Kim, J.H. Pure Laparoscopic Right Posterior Sectionectomy Using the Glissonean Approach and a Modified Liver Hanging Maneuver (Video). J Gastrointest Surg 23, 825–826 (2019). https://doi.org/10.1007/s11605-018-4066-5
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DOI: https://doi.org/10.1007/s11605-018-4066-5