Extrahepatic Glissonean Access in Laparoscopic Anatomical Liver Resection

Akihiro Cho, MD, Hiroshi Yamamoto, MD, Osamu Kainuma, MD, Atsushi Ikeda, MD, Hiroaki Souda, MD, Yoshihiro Nabeya, MD, Nobuhiro Takiguchi, MD. Chiba Cancer Center Hospital, Japan


Background: Although recent technological developments and improved endoscopic procedures have further spread the application of laparoscopic liver resection, laparoscopic anatomical liver resection has not yet become widely accepted due to the technical difficulties in controlling each Glissonean pedicle laparoscopically.
Methods: The subjects in the present study included 24 patients (8 female, 16 male) who underwent laparoscopic anatomical liver resection using extrahepatic Glissonean access. The mean patient age at the time of resection was 68.2 years (range, 43-78 years). The postoperative outcomes were retrospectively analyzed.
Surgical technique: The metallic arch of an Endo Retract Maxi (Covidien Japan, Tokyo, Japan) is extended between the hepatic parenchyma and the bifurcation of the right and left Glissonean pedicles, so the right or left Glisonean pedicle is encircled extrahepatically. In the same way, the anterior or posterior Glisonean pedicle is extrahepatically encircled. Retracting the round ligament and gallbladder allows a good operative field of view, facilitating the encircling of each Glissonean pedicle. Each Glissonean pedicle is divided en bloc using an endoscopic stapling system based on resection type.
Results: All Glissonean pedicles could be encircled en bloc extrahepatically, as planned. No serious complications, including major bleeding or injury of the portal triad, were encountered during procedures. No postoperative mortality was encountered in any of the 24 patients. The mean length of surgery was 374±119 minutes, and the mean blood loss was 365±211g. The duration of the hospital stay was 17.5±3.5 days.
Conclusions: Extrahepatic Glissonean access appears feasible and safe for laparoscopic anatomical resection of the liver.
Conflict of Interest: We have no conflicts of interest or financial ties to disclose.

Session Number: SS19 – Videos: HPB (Hepatobiliary and Pancreas)
Program Number: V033

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