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Pure Laparoscopic Anatomic Resection of the Segment 8 Ventral Area Using the Transfissural Glissonean Approach

  • Ji Hoon KimEmail author
  • Hyeyoung Kim
Hepatobiliary Tumors

Abstract

Background

Pure laparoscopic anatomic resection of liver segment 8 still is rarely performed due to technical difficulties and the anatomic complexity.1,2 Limited resection of the segment 8 ventral area has been possible because the right anterior section can be divided into ventral and dorsal areas.3,4 This report describes the technique of pure laparoscopic anatomic resection of the segment 8 ventral area using the transfissural Glissonean approach.

Methods

A 43-year-old woman who had been taking oral contraceptives for 3 years was referred for treatment of a single nodular tumor located in the segment 8 ventral area. The surgical procedure involved the following steps: (1) dissection and clamping of the right Glissonean pedicle, (2) identification of the main portal fissure, (3) parenchymal dissection along the main portal fissure,58 (4) dissection and ligation of the segment 8 ventral portal pedicle, and (5) transection of the ischemic demarcation line of the segment 8 ventral area.

Results

The operative time was 180 min, and the estimated blood loss was 30 mL. The total Pringle maneuver time was 45 min. The final histopathologic diagnosis was an adenoma. The tumor size was 6 mm, and the resection margin was negative. The patient had an uneventful postoperative recovery, and she was discharged on postoperative day 3.

Conclusion

The transfissural Glissonean approach for laparoscopic anatomic resection of the segment 8 ventral area is a feasible and effective technique. Opening of the main portal fissure allows easy and direct access to the segment 8 ventral branch.

Notes

Disclosure

There are no conflicts of interest.

Informed consent

The patient in this study received an explanation of the procedure and provided informed consent. This study was approved by the institutional review board.

Supplementary material

Supplementary material 1 (WMV 278093 kb)

References

  1. 1.
    Jang JY, Han HS, Yoon YS, Cho JY. Three-dimensional laparoscopic anatomical segment 8 liver resection with Glissonian approach. Ann Surg Oncol. 2017;24:1606–9.CrossRefGoogle Scholar
  2. 2.
    Berardi G, Wakabayashi G, Igarashi K, et al. Full laparoscopic anatomical segment 8 resection for hepatocellular carcinoma using the Glissonian approach with indocyanine green dye fluorescence. Ann Surg Oncol. 2019;26:2577–8.  https://doi.org/10.1245/s10434-019-07422-8.CrossRefPubMedGoogle Scholar
  3. 3.
    Kobayashi T, Ebata T, Yokoyama Y, et al. Study on the segmentation of the right anterior sector of the liver. Surgery. 2017;161:1536–42.CrossRefGoogle Scholar
  4. 4.
    Kurimoto A, Yamanaka J, Hai S, et al. Parenchyma-preserving hepatectomy based on portal ramification and perfusion of the right anterior section: preserving the ventral or dorsal area. J Hepatobiliary Pancreat Sci. 2016;23:158–66.CrossRefGoogle Scholar
  5. 5.
    Couinaud C. Surgical anatomy of the liver revisited. Selfprinted, Paris, France, 1989:29–48.Google Scholar
  6. 6.
    Wang HJ. Anatomical liver resection: Glissonean approach (in Korean). In: Koonja. 2015;67–85.Google Scholar
  7. 7.
    Kim JH, Kim H. Pure laparoscopic anatomical segment V resection using the extrafascial and transfissural Glissonean approach. Ann Surg Oncol. 2019;26:2241.CrossRefGoogle Scholar
  8. 8.
    Kim JH. Pure laparoscopic anatomical resection of the ventral area of the right anterior section using the transfissural Glissonean approach. J Gastrointest Surg. 2019;23:1279–82.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of SurgeryEulji University College of MedicineDaejeonRepublic of Korea
  2. 2.Department of SurgeryEulji University HospitalDaejeonRepublic of Korea

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