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Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

One of the main criticisms of laparoscopic liver resection is that it is difficult, or not possible, to perform liver-sparing resections. Our aim was to present short videos where the intrahepatic Glissonian approach was used to perform anatomical liver segmental resections, instead of a larger operation, to avoid unnecessary sacrifice of the liver parenchyma.

Methods

We selected six types of anatomical liver resections to exemplify the use of the intrahepatic Glissonian approach to perform segment-oriented liver resections. These types of hepatectomies were used as an alternative to right or left hepatectomy, or as an alternative to extended liver resections.

Results

The intrahepatic Glissonian approach was feasible in all cases. The use of anatomical landmarks previously described was essential to reach and control the Glissonian pedicles. Among the liver-sparing resections, we were able to perform right anterior (S5 + S8) and posterior (S6 + S7) sectionectomies, resection of segments 2, 3, and 4, and mesohepatectomy (S4 + S5 + S8). No patient presented postoperative liver failure.

Conclusions

Laparoscopic liver-sparing resections are feasible and may be a good alternative to hemihepatectomies or extended liver resections. The use of the intrahepatic Glissonian approach can be useful.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of São Paulo, São Paulo, Brazil

    Marcel Autran C. Machado MD, FACS, R. Surjan MD, T. Basseres MD & F. Makdissi MD

Authors
  1. Marcel Autran C. Machado MD, FACS
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  2. R. Surjan MD
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  3. T. Basseres MD
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  4. F. Makdissi MD
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Corresponding author

Correspondence to Marcel Autran C. Machado MD, FACS.

Electronic supplementary material

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10434_2017_5886_MOESM1_ESM.mp4

This video shows six situations where the intrahepatic Glissonian approach was used to perform laparoscopic parenchymal-sparing liver resections (anatomical hepatectomies) instead of a larger operation such as hemihepatectomy or trisectionectomy. Supplementary material 1 (MP4 132509 kb)

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Machado, M.A.C., Surjan, R., Basseres, T. et al. Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach. Ann Surg Oncol 24, 2353–2354 (2017). https://doi.org/10.1245/s10434-017-5886-3

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  • DOI: https://doi.org/10.1245/s10434-017-5886-3

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