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Glissonian approach combined with major hepatic vein first?a novel strategy for laparoscopic anatomic hepatectomy

Decai Yu, MD, PhD, Xingyu Wu, MD, PhD, Xitai Sun, MD, PhD, Yitao Ding, MD, PhD. Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, P.R. China.

Background: Laparoscopic anatomic hepatectomy (LAH) is still challenging because of complex intrahepatic ducts and shortage of real time guidance. Our novel strategy, including Glissonian approach and major hepatic vein (mHV) first is used to overcome the challenges for LAH. We present eleven cases undergoing LAH with this strategy.

Methods: eleven cases underwent LAH, including 3 right hepatectomies, 3 left hepatectomies, 3 right posterior hepatectomies, 2 mesohepatectomies. Eight cases have hepatocellular carcinoma as three have hepatolithiasis. The operation began first with division of liver ligaments. Glissonian approach served to isolate and dissect the hepatic pedicles corresponding to resected lobes as external demarcation. Then we exposed the aimed mHV near hepatic portal, and isolated its trend, which served as the internal landmark for parenchymal transection. Liver parenchymal below and above mHV was transected along mHV and toward the root of mHV. Lastly the root or branches of mHV was dissected. In addition, 59 subjects, including healthy subjects, hemangioma, cirrhosis, hepatolithiasis, and hepatocellular carcinoma, served to compare the distance between mHV and secondary Glisson pedicles among different liver diseases.

Results: The average of operation time was 327 min with estimated blood loss 554.55 ml. Only two patients received 3 units packed red blood cells. C reactive protein was up to 33.5 mg/L. Case 10 suffered from bile leakage, while Case 11 suffered from acute liver dysfunction. The others were recovered normal and discharged on the postoperative day 7. In the liver with cirrhosis, only RHV-RPG was shorter than one without cirrhosis. In the patient with HCC, RHV-RPG was the shortest among five groups with different liver diseases.

Conclusions: Glissonian approach with mHV first is easy and feasible for LAH, especially for right posterior hepatectomy in the patients with hepatocellular carcinoma and liver cirrhosis. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 84999

Program Number: V249

Presentation Session: Thursday Video Loop (Non CME)

Presentation Type: VideoLoop

43

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