Advertisement

Annals of Surgical Oncology

, Volume 26, Issue 7, pp 2241–2241 | Cite as

Pure Laparoscopic Anatomical Segment V Resection Using the Extrafascial and Transfissural Glissonean Approach

  • Ji Hoon KimEmail author
  • Hyeyoung Kim
Hepatobiliary Tumors

Abstract

Background

The Glissonean approach is a widely used, effective technique for anatomical segmentectomy using an open or laparoscopic approach.14 In the extrafascial Glissonean approach, the deep tertiary branches of the right anterior portal pedicle may be difficult to dissect from the liver hilum.5,6 We present a pure laparoscopic anatomical segment V resection using the extrafascial and transfissural Glissonean approach.

Methods

A 49-year-old man presented with a single mass in segment 5 of the liver. (1) Dissection of the right anterior portal pedicle: the right anterior portal pedicle was dissected meticulously. After temporary clamping of the pedicle, the main and right portal fissure were delineated. (2) Opening of the main and right portal fissure: the main and right portal fissure were opened for approaching the deep tertiary segment V portal pedicle.7,8 (3) Dissection of the segment V portal pedicle: the segment V portal pedicle was dissected and the segment V territory was confirmed. After dissection of the segment V hepatic vein, the remnant liver parenchyma was transected.

Results

The operation time was 280 min, the estimated blood loss was 80 mL, and the total Pringle maneuver time was 45 min. Final histopathological diagnosis showed a 2.8 cm-sized hepatocellular carcinoma with negative resection margin. The patient was discharged on postoperative day 6 without any complications.

Conclusion

The extrafascial and transfissural approach in laparoscopic anatomical segment V resection is feasible and effective, and allows easy and direct access to the segment V portal pedicle.

Notes

DISCLOSURES

Ji Hoon Kim and Hyeyoung Kim have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 292124 kb)

References

  1. 1.
    Couinaud C. Surgical anatomy of the liver revisited. Paris: Self-printed; 1989.Google Scholar
  2. 2.
    Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg 1998; 5:286–91.CrossRefPubMedGoogle Scholar
  3. 3.
    Sugioka A, Kato Y, Tanabashi Y. 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. 2017; 24:17–23.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Ahn KS, Han HS, Yoon YS, et al. Laparoscopic anatomical S5 segmentectomy by the Glissonian approach. J Laparoendosc Adv Surg Tech A. 2011;21:345–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Yamamoto M, Ariizumi S. Glissonean pedicle approach in liver surgery. Ann Gastroenterol Surg 2018; 2:124–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Yamamoto M, Katagiri S, Ariizumi S, et al. Tips for anatomical hepatectomy for hepatocellular carcinoma by the Glissonean pedicle approach (with videos) J Hepatobiliary Pancreat Sci 2014; 21:E53–6.Google Scholar
  7. 7.
    Lin TT. A simplified technique for hepatic resection: the crush method. Ann Surg. 1974;180:285–90.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Wang HJ. Anatomical liver resection: Glissonean approach [in Korean]. Koonja, 2015. pp. 77–78.Google Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Surgery, College of MedicineEulji UniversityDaejeonRepublic of Korea
  2. 2.Department of SurgeryEulji University HospitalDaejeonRepublic of Korea

Personalised recommendations