Abstract
Aim
To present a video of laparoscopic right hepatectomy using Glissonian technique. A new strategy for liver transection is presented. Liver is divided in three parts. The posterior part, containing short hepatic veins, is divided with stapler before liver transection. Anterior part is fully divided with harmonic scalpel, and the middle part, containing hepatic veins from segments 5 and 8, is the last part to be transected.
Patient and method
A 41-year-old woman with right-sided hepatolithiasis and choledocholithiasis was referred for surgical treatment. Patient was positioned in left lateral position. Four trocars were used. Operation began with division of liver ligaments, right liver mobilization, and exposure of the retrohepatic vena cava. Cholecystectomy was performed, followed by intrahepatic access to the right Glissonian pedicle (containing arterial, portal, and bile duct branches of segments 5–8). Two small incisions were performed around hilar plate according to specific anatomic landmarks. A vascular clamp was introduced into those incisions, resulting in ischemic delineation of right liver. Clamp was replaced by a vascular stapler, and stapler was fired. Liver parenchyma was divided by harmonic scalpel combined with vascular stapler. The specimen was extracted through suprapubic incision. Intraoperative cholangiography confirmed a 2-cm common bile duct stone which was immediately removed by endoscopy (endoscopic retrograde cholangiopancreatography, ERCP). Falciform ligament was sutured to maintain the liver in its original anatomical position, avoiding hepatic vein kinking, and abdominal cavity was drained.
Results
Operative time was 180 min, with blood loss estimated at 50 ml, without need for transfusion. Postoperative recovery was uneventfully, and patient was discharged on the fourth postoperative day.
Conclusion
Laparoscopic intrahepatic Glissonian approach is feasible and is a useful technique for rapid and safe control of the right liver pedicle, facilitating laparoscopic right hemihepatectomy. The special strategy described may help laparoscopic surgeons to safely perform this challenging procedure.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Dagher I, Giuro GD, Dubrez J, Lainas P, Smadja C, Franco D (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177
Machado MA, Makdissi FF, Galvão FH, Machado MC (2008) Intrahepatic Glissonian approach for laparoscopic right segmental liver resections. Am J Surg 196:e38–e42
Machado MA, Makdissi FF, Surjan RC, Herman P, Teixeira AR, Machado MC (2009) Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach. Surg Endosc 23:2615– 2619
Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94(1):58–63
Topal B, Aerts R, Penninckx F (2007) Laparoscopic intrahepatic Glissonian approach for right hepatectomy is safe, simple, and reproducible. Surg Endosc 21:2111
Han HS, Yoon YS, Cho JY, Ahn KS (2010) Laparoscopic right hemihepatectomy for hepatocellular carcinoma. Ann Surg Oncol 17:2090–2091
Machado MA, Herman P, Figueira ER, Bacchella T, Machado MC (2006) Intrahepatic Glissonian access for segmental liver resection in cirrhotic patients. Am J Surg 192:388–392
Machado MA, Herman P, Machado MC (2003) Standardized technique for segmental right liver resections. Arch Surg 138: 918–920
Machado MA, Herman P, Machado MC (2004) Anatomical resection of left liver segments. Arch Surg 139:1346–1349
Disclosures
Authors Machado, Surjan, and Makdissi have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (WMV 108000 kb)
Rights and permissions
About this article
Cite this article
Machado, M.A., Surjan, R.C. & Makdissi, F.F. Intrahepatic Glissonian approach for pure laparoscopic right hemihepatectomy. Surg Endosc 25, 3930–3933 (2011). https://doi.org/10.1007/s00464-011-1812-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1812-0